- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,969.03 / $5,048.00 / $9,539.00
| Facility | | $2,969.03 | $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
- $2,418.06 / $2,901.67 / $3,578.73
| Professional | | $2,418.06 | $2,901.67 | $3,578.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,888.06 / $3,623.93 / $5,263.12
| Facility | | $2,888.06 | $3,623.93 | $5,263.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $570.62 / $642.13 / $785.10
| Facility | AS | $570.62 | $642.13 | $785.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,191.15 / $3,288.23 / $6,313.22
| Facility | | $2,191.15 | $3,288.23 | $6,313.22 |
- 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 |