- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,897.79 / $7,413.10
| Facility | | $1,148.15 | $4,897.79 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,754.23 / $6,025.60
| Facility | | $1,174.90 | $2,754.23 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $2,187.76
| Facility | | $1,000.00 | $1,412.54 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $141.25 / $141.25 / $141.25
| Facility | AS | $141.25 | $141.25 | $141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,380.38 / $6,606.93
| Professional | | $891.25 | $1,380.38 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $33.11 / $33.11 / $41.69
| Professional | AS | $33.11 | $33.11 | $41.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.02 / $4,168.69 / $6,918.31
| Facility | | $1,122.02 | $4,168.69 | $6,918.31 |