- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $847.82 / $1,332.31 / $2,351.77
| Professional | | $847.82 | $1,332.31 | $2,351.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.83 / $2,196.48 / $6,608.00
| Facility | | $1,289.83 | $2,196.48 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $417.36 / $417.36 / $417.36
| Facility | AS | $417.36 | $417.36 | $417.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,381.05 / $2,006.53 / $2,702.64
| Facility | | $1,381.05 | $2,006.53 | $2,702.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |