- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,128.61 / $9,549.93
| Facility | | $1,023.29 | $5,128.61 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,090.30 / $6,025.60
| Facility | | $1,230.27 | $3,090.30 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,348.96 / $2,187.76
| Facility | | $1,000.00 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $851.14 / $3,235.94
| Professional | | $630.96 | $851.14 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $23.44 / $23.44 / $23.44
| Professional | AS | $23.44 | $23.44 | $23.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,623.41 / $8,511.38
| Facility | | $1,513.56 | $5,623.41 | $8,511.38 |