- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,872.03 / $5,048.00 / $9,539.00
| Facility | | $2,872.03 | $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
- $2,335.01 / $2,802.01 / $3,455.81
| Professional | | $2,335.01 | $2,802.01 | $3,455.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,789.95 / $3,382.66 / $4,994.13
| Facility | | $2,789.95 | $3,382.66 | $4,994.13 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $467.23 / $546.55 / $708.10
| Facility | AS | $467.23 | $546.55 | $708.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.00 / $3,148.34 / $6,078.69
| Facility | | $2,070.00 | $3,148.34 | $6,078.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |