- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $5,623.41 / $9,549.93
| Facility | | $2,884.03 | $5,623.41 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $5,370.32 / $11,220.18
| Facility | | $2,187.76 | $5,370.32 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,951.21 / $58,884.37
| Facility | | $501.19 | $2,951.21 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Facility | AS | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,754.23 / $9,549.93
| Professional | | $1,905.46 | $2,754.23 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $79.43 / $79.43 / $79.43
| Professional | AS | $79.43 | $79.43 | $79.43 |
- 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 |