- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.51 / $1,230.41 / $2,523.25
| Professional | | $789.51 | $1,230.41 | $2,523.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $878.14 / $1,838.82 / $8,369.10
| Facility | | $878.14 | $1,838.82 | $8,369.10 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,045.32 / $1,045.32 / $1,045.32
| Facility | AS | $1,045.32 | $1,045.32 | $1,045.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,369.80 / $2,097.19 / $3,701.41
| Facility | | $1,369.80 | $2,097.19 | $3,701.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |