- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,760.83 / $13,803.84
| Facility | | $2,570.40 | $6,760.83 | $13,803.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,370.32 / $14,454.40
| Facility | | $2,041.74 | $5,370.32 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,918.31 / $10,000.00
| Facility | | $2,238.72 | $6,918.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,148.15 / $4,466.84
| Professional | | $851.14 | $1,148.15 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $32.36 / $32.36 / $32.36
| Professional | AS | $32.36 | $32.36 | $32.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,413.10 / $17,378.01
| Facility | | $1,995.26 | $7,413.10 | $17,378.01 |