- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,585.78 / $10,232.93 / $16,595.87
| Facility | | $7,585.78 | $10,232.93 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $6,456.54 / $13,182.57
| Facility | | $2,754.23 | $6,456.54 | $13,182.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $1,000.00 / $2,238.72
| Facility | | $562.34 | $1,000.00 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $758.58 / $912.01
| Professional | | $758.58 | $758.58 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $758.58 / $1,230.27
| Facility | | $562.34 | $758.58 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $12,589.25 / $22,908.68
| Facility | | $1,230.27 | $12,589.25 | $22,908.68 |