- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $3,162.28 / $8,511.38
| Facility | | $501.19 | $3,162.28 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $1,023.29
| Professional | | $323.59 | $467.74 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,265.80 / $10,000.00
| Facility | | $1,698.24 | $4,265.80 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $933.25
| Professional | | $323.59 | $467.74 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,412.54 / $4,168.69
| Facility | | $575.44 | $1,412.54 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $57.54 / $57.54 / $57.54
| Facility | AS | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $602.56 / $1,318.26
| Professional | | $371.54 | $602.56 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $2,884.03 / $6,309.57
| Facility | | $1,023.29 | $2,884.03 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $501.19 / $933.25
| Professional | | $331.13 | $501.19 | $933.25 |