- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $11,100.08
| Facility | | $4,277.00 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,131.07 / $3,453.98 / $6,884.00
| Professional | | $2,131.07 | $3,453.98 | $6,884.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,136.33 / $4,861.31 / $6,450.88
| Facility | | $3,136.33 | $4,861.31 | $6,450.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,057.84 / $1,057.84 / $1,057.84
| Facility | AS | $1,057.84 | $1,057.84 | $1,057.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,007.11 / $5,085.83 / $6,548.28
| Facility | | $4,007.11 | $5,085.83 | $6,548.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,854.53 / $7,407.10
| Facility | | $2,126.00 | $5,854.53 | $7,407.10 |