- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $5,623.41 / $9,549.93
| Facility | | $1,380.38 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,818.38 / $5,754.40
| Facility | | $912.01 | $2,818.38 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $1,000.00 / $2,630.27
| Facility | | $512.86 | $1,000.00 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $758.58 / $1,348.96
| Professional | | $575.44 | $758.58 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $21.88 / $21.88 / $27.54
| Professional | AS | $21.88 | $21.88 | $27.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $4,677.35 / $8,511.38
| Facility | | $660.69 | $4,677.35 | $8,511.38 |