- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.21 / $6,028.00 / $11,749.67
| Facility | | $1,288.21 | $6,028.00 | $11,749.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,350.00 / $15,967.00 / $34,838.00
| Facility | | $9,350.00 | $15,967.00 | $34,838.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,823.94 / $6,823.94 / $21,495.79
| Facility | | $6,823.94 | $6,823.94 | $21,495.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $844.13 / $1,068.73 / $1,462.60
| Facility | | $844.13 | $1,068.73 | $1,462.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.35 / $1,211.86 / $1,671.54
| Professional | | $919.35 | $1,211.86 | $1,671.54 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $22.73 / $22.73 / $22.73
| Professional | AS | $22.73 | $22.73 | $22.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,146.00 / $13,967.00 / $20,534.00
| Facility | | $11,146.00 | $13,967.00 | $20,534.00 |