- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,907.91 / $5,876.00 / $10,255.42
| Facility | | $2,907.91 | $5,876.00 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $868.39 / $1,364.25 / $3,068.83
| Professional | | $868.39 | $1,364.25 | $3,068.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.02 / $1,974.07 / $4,663.00
| Facility | | $1,187.02 | $1,974.07 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $428.11 / $428.11 / $428.11
| Facility | AS | $428.11 | $428.11 | $428.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,393.98 / $2,058.21 / $2,800.42
| Facility | | $1,393.98 | $2,058.21 | $2,800.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |