- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,590.56 / $5,378.94 / $10,651.00
| Facility | | $1,590.56 | $5,378.94 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,586.00 / $8,579.00 / $17,457.75
| Facility | | $4,586.00 | $8,579.00 | $17,457.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,022.70 / $1,308.53 / $1,744.71
| Facility | | $1,022.70 | $1,308.53 | $1,744.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.75 / $1,473.40 / $2,032.28
| Professional | | $1,117.75 | $1,473.40 | $2,032.28 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $27.64 / $27.64 / $27.64
| Professional | AS | $27.64 | $27.64 | $27.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,251.00 / $11,924.00 / $19,712.00
| Facility | | $9,251.00 | $11,924.00 | $19,712.00 |