- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,370.32 / $7,413.10
| Facility | | $2,041.74 | $5,370.32 | $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 / $2,511.89 / $3,467.37
| Facility | | $501.19 | $2,511.89 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $346.74 / $346.74 / $346.74
| Facility | AS | $346.74 | $346.74 | $346.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,630.27 / $11,481.54
| Professional | | $1,995.26 | $2,630.27 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $120.23 / $120.23 / $120.23
| Professional | AS | $120.23 | $120.23 | $120.23 |
- 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 |