- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $5,370.32 / $7,413.10
| Facility | | $1,659.59 | $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 / $1,548.82 / $6,456.54
| Facility | | $1,000.00 | $1,548.82 | $6,456.54 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,258.93 / $5,011.87
| Professional | | $954.99 | $1,258.93 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $36.31 / $36.31 / $36.31
| Professional | AS | $36.31 | $36.31 | $36.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,413.10 / $17,378.01
| Facility | | $1,995.26 | $7,413.10 | $17,378.01 |