- 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
- $2,561.54 / $4,025.32 / $7,167.53
| Professional | | $2,561.54 | $4,025.32 | $7,167.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,147.42 / $6,303.18 / $7,815.64
| Facility | | $4,147.42 | $6,303.18 | $7,815.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,251.32 / $1,251.32 / $1,251.32
| Facility | AS | $1,251.32 | $1,251.32 | $1,251.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,181.35 / $6,015.96 / $8,161.16
| Facility | | $4,181.35 | $6,015.96 | $8,161.16 |
- 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 |