- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.50 / $4,771.00 / $9,966.59
| Facility | | $945.50 | $4,771.00 | $9,966.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.37 / $886.28 / $1,047.42
| Professional | | $691.37 | $886.28 | $1,047.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.85 / $853.52 / $1,372.62
| Facility | | $663.85 | $853.52 | $1,372.62 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $112.04 / $155.74 / $239.17
| Facility | AS | $112.04 | $155.74 | $239.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.45 / $868.19 / $2,696.56
| Facility | | $625.45 | $868.19 | $2,696.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,061.00 / $8,168.00 / $17,187.00
| Facility | | $5,061.00 | $8,168.00 | $17,187.00 |