- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,365.66 / $5,048.00 / $9,539.00
| Facility | | $2,365.66 | $5,048.00 | $9,539.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,918.43 / $2,302.12 / $2,839.28
| Professional | | $1,918.43 | $2,302.12 | $2,839.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,173.77 / $2,673.80 / $3,997.97
| Facility | | $2,173.77 | $2,673.80 | $3,997.97 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.77 / $509.77 / $583.11
| Facility | AS | $331.77 | $509.77 | $583.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,724.83 / $2,557.28 / $5,005.14
| Facility | | $1,724.83 | $2,557.28 | $5,005.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,713.00 / $3,295.00 / $5,790.00
| Facility | | $1,713.00 | $3,295.00 | $5,790.00 |