- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $8,511.38 / $34,673.69
| Facility | | $6,025.60 | $8,511.38 | $34,673.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $14,791.08 / $28,840.32
| Facility | | $11,220.18 | $14,791.08 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,570.40 / $8,128.31
| Facility | | $1,513.56 | $2,570.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $794.33 / $794.33 / $794.33
| Facility | AS | $794.33 | $794.33 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,890.45 / $5,370.32
| Professional | | $3,235.94 | $3,890.45 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $7,244.36 / $10,000.00
| Facility | | $6,165.95 | $7,244.36 | $10,000.00 |