- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $4,570.88 / $7,413.10
| Facility | | $1,479.11 | $4,570.88 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $6,025.60
| Facility | | $1,230.27 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,584.89 / $2,511.89
| Facility | | $501.19 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $5,128.61
| Professional | | $1,000.00 | $1,258.93 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Professional | AS | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $17,378.01
| Facility | | $1,995.26 | $7,762.47 | $17,378.01 |