- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,490.65 / $5,265.77 / $10,301.40
| Facility | | $3,490.65 | $5,265.77 | $10,301.40 |
- 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
- $2,818.07 / $3,381.68 / $4,170.74
| Professional | | $2,818.07 | $3,381.68 | $4,170.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,088.54 / $3,999.28 / $5,820.19
| Facility | | $3,088.54 | $3,999.28 | $5,820.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $580.17 / $657.38 / $860.93
| Facility | AS | $580.17 | $657.38 | $860.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,972.65 / $3,773.64 / $7,382.66
| Facility | | $1,972.65 | $3,773.64 | $7,382.66 |
- 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 |