- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.89 / $4,033.00 / $7,119.04
| Facility | | $2,044.89 | $4,033.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.58 / $1,126.44 / $1,473.32
| Professional | | $664.58 | $1,126.44 | $1,473.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.33 / $2,098.30 / $14,428.30
| Facility | | $1,264.33 | $2,098.30 | $14,428.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,618.01 / $1,618.01 / $1,618.01
| Facility | AS | $1,618.01 | $1,618.01 | $1,618.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.33 / $2,120.40 / $5,661.05
| Facility | | $1,264.33 | $2,120.40 | $5,661.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |