- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,370.32 / $9,549.93
| Facility | | $1,348.96 | $5,370.32 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,265.80 / $12,022.64
| Facility | | $1,258.93 | $4,265.80 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,905.46
| Facility | | $1,000.00 | $1,000.00 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Facility | AS | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,659.59 / $6,165.95
| Professional | | $1,202.26 | $1,659.59 | $6,165.95 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Professional | AS | $43.65 | $43.65 | $43.65 |
- 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 |