- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $6,606.93 / $7,079.46
| Facility | | $1,202.26 | $6,606.93 | $7,079.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,819.70
| Professional | | $1,230.27 | $1,230.27 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $1,000.00 / $1,513.56
| Facility | | $776.25 | $1,000.00 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $6,918.31 / $10,471.29
| Facility | | $1,659.59 | $6,918.31 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $5,495.41 / $28,840.32
| Facility | | $5,495.41 | $5,495.41 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $549.54 / $549.54 / $549.54
| Facility | AS | $549.54 | $549.54 | $549.54 |