- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.28 / $5,370.32 / $7,413.10
| Facility | | $1,778.28 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,890.45 / $11,220.18
| Facility | | $1,288.25 | $3,890.45 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,380.38
| Facility | | $1,000.00 | $1,000.00 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,202.26 / $4,466.84
| Professional | | $831.76 | $1,202.26 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $31.62 / $31.62 / $31.62
| Professional | AS | $31.62 | $31.62 | $31.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $6,456.54 / $12,022.64
| Facility | | $1,737.80 | $6,456.54 | $12,022.64 |