- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $818.64 / $1,260.56 / $2,713.02
| Professional | | $818.64 | $1,260.56 | $2,713.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,010.07 / $2,072.55 / $12,257.52
| Facility | | $1,010.07 | $2,072.55 | $12,257.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,625.25 / $1,625.25 / $1,625.25
| Facility | AS | $1,625.25 | $1,625.25 | $1,625.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,571.00 / $1,959.23 / $2,631.63
| Facility | | $1,571.00 | $1,959.23 | $2,631.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |