- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $443.03 / $5,006.12 / $11,627.80
| Facility | | $443.03 | $5,006.12 | $11,627.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.47 / $424.90 / $645.32
| Professional | | $358.47 | $424.90 | $645.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.37 / $485.33 / $528.77
| Facility | | $432.37 | $485.33 | $528.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.17 / $470.02 / $470.02
| Professional | | $241.17 | $470.02 | $470.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.38 / $462.38 / $462.38
| Facility | | $462.38 | $462.38 | $462.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $45.93 / $45.93 / $45.93
| Facility | AS | $45.93 | $45.93 | $45.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.93 / $601.07 / $1,161.04
| Professional | | $393.93 | $601.07 | $1,161.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,963.13 / $2,963.13 / $2,963.13
| Facility | | $2,963.13 | $2,963.13 | $2,963.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.00 / $2,450.00 / $2,450.00
| Facility | | $2,450.00 | $2,450.00 | $2,450.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.84 / $513.19 / $711.11
| Professional | | $327.84 | $513.19 | $711.11 |