- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,235.94 / $6,760.83
| Facility | | $1,000.00 | $3,235.94 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $891.25 / $2,089.30
| Professional | | $588.84 | $891.25 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $1,348.96 / $8,128.31
| Facility | | $794.33 | $1,348.96 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,445.44 / $1,737.80
| Professional | | $1,288.25 | $1,445.44 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,128.61 / $8,511.38 / $11,748.98
| Facility | | $5,128.61 | $8,511.38 | $11,748.98 |