- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,623.41 / $9,549.93
| Facility | | $2,884.03 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $6,025.60
| Facility | | $1,230.27 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,511.89 / $2,754.23
| Facility | | $501.19 | $2,511.89 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.42 / $275.42 / $275.42
| Facility | AS | $275.42 | $275.42 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,290.87 / $8,912.51
| Professional | | $1,778.28 | $2,290.87 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $64.57 / $64.57 / $64.57
| Professional | AS | $64.57 | $64.57 | $64.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $17,378.01
| Facility | | $1,995.26 | $7,762.47 | $17,378.01 |