- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,049.92 / $3,402.15 / $5,414.23
| Professional | | $2,049.92 | $3,402.15 | $5,414.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,977.74 / $4,906.80 / $6,608.00
| Facility | | $2,977.74 | $4,906.80 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,020.61 / $1,020.61 / $1,020.61
| Facility | AS | $1,020.61 | $1,020.61 | $1,020.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,142.31 / $4,709.38 / $6,159.56
| Facility | | $3,142.31 | $4,709.38 | $6,159.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,854.53 / $7,305.00
| Facility | | $2,126.00 | $5,854.53 | $7,305.00 |