- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.72 / $955.59 / $2,597.92
| Professional | | $599.72 | $955.59 | $2,597.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,019.18 / $1,593.40 / $11,139.12
| Facility | | $1,019.18 | $1,593.40 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,440.41 / $2,440.41 / $2,440.41
| Facility | AS | $2,440.41 | $2,440.41 | $2,440.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,192.78 / $1,593.40 / $9,078.45
| Facility | | $1,192.78 | $1,593.40 | $9,078.45 |
- 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 |