- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $7,119.04 / $11,611.47
| Facility | | $5,091.00 | $7,119.04 | $11,611.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,932.00 / $1,932.00 / $1,932.00
| Facility | | $1,932.00 | $1,932.00 | $1,932.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.71 / $1,625.21 / $3,539.99
| Professional | | $978.71 | $1,625.21 | $3,539.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.81 / $2,563.41 / $11,732.00
| Facility | | $1,516.81 | $2,563.41 | $11,732.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,568.44 / $1,568.44 / $1,568.44
| Facility | AS | $1,568.44 | $1,568.44 | $1,568.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,893.00 / $2,759.03 / $5,383.60
| Facility | | $1,893.00 | $2,759.03 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $7,487.00 / $11,732.00
| Facility | | $1,770.00 | $7,487.00 | $11,732.00 |