- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,463.36 / $10,563.53
| Facility | | $4,146.00 | $5,463.36 | $10,563.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.03 / $1,063.47 / $1,855.79
| Professional | | $578.03 | $1,063.47 | $1,855.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.67 / $1,552.55 / $8,342.00
| Facility | | $918.67 | $1,552.55 | $8,342.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $266.74 / $266.74 / $266.74
| Facility | AS | $266.74 | $266.74 | $266.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.39 / $1,718.33 / $8,867.76
| Facility | | $1,282.39 | $1,718.33 | $8,867.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |