- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $5,623.41 / $11,481.54
| Facility | | $1,862.09 | $5,623.41 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $3,890.45 / $13,182.57
| Facility | | $1,174.90 | $3,890.45 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,918.31 / $10,000.00
| Facility | | $1,380.38 | $6,918.31 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | AS | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $954.99 / $3,715.35
| Professional | | $707.95 | $954.99 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $26.30 / $26.30 / $26.30
| Professional | AS | $26.30 | $26.30 | $26.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $8,511.38 / $8,511.38
| Facility | | $7,413.10 | $8,511.38 | $8,511.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,754.40 / $13,182.57
| Facility | | $1,513.56 | $5,754.40 | $13,182.57 |