- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,149.31 / $3,277.55 / $7,119.04
| Facility | | $3,149.31 | $3,277.55 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $975.51 / $1,524.21 / $3,096.63
| Professional | | $975.51 | $1,524.21 | $3,096.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,303.33 / $2,126.00 / $4,663.00
| Facility | | $1,303.33 | $2,126.00 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $479.42 / $479.42 / $479.42
| Facility | AS | $479.42 | $479.42 | $479.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.85 / $2,304.92 / $3,154.48
| Facility | | $1,581.85 | $2,304.92 | $3,154.48 |
- 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 |