- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.89 / $5,048.00 / $9,539.00
| Facility | | $2,767.89 | $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
- $2,245.23 / $2,694.28 / $3,322.94
| Professional | | $2,245.23 | $2,694.28 | $3,322.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,693.23 / $3,396.95 / $4,917.12
| Facility | | $2,693.23 | $3,396.95 | $4,917.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $530.86 / $596.55 / $717.69
| Facility | AS | $530.86 | $596.55 | $717.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,070.00 / $3,051.36 / $5,858.44
| Facility | | $2,070.00 | $3,051.36 | $5,858.44 |
- 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 |