- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,265.80 / $6,760.83 / $10,964.78
| Facility | | $4,265.80 | $6,760.83 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $6,025.60
| Facility | | $1,230.27 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $1,584.89 / $2,511.89
| Facility | | $501.19 | $1,584.89 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $158.49 / $158.49 / $158.49
| Facility | AS | $158.49 | $158.49 | $158.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,000.00 / $3,715.35
| Professional | | $954.99 | $1,000.00 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $28.18 / $28.18 / $28.18
| Professional | AS | $28.18 | $28.18 | $28.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $17,378.01
| Facility | | $1,995.26 | $7,762.47 | $17,378.01 |