- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,486.83 / $5,549.00 / $10,377.00
| Facility | | $2,486.83 | $5,549.00 | $10,377.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $769.07 / $1,177.75 / $2,546.23
| Professional | | $769.07 | $1,177.75 | $2,546.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $980.54 / $2,028.73 / $14,479.00
| Facility | | $980.54 | $2,028.73 | $14,479.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,561.40 / $2,561.40 / $2,561.40
| Facility | AS | $2,561.40 | $2,561.40 | $2,561.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,452.00 / $2,046.01 / $8,965.75
| Facility | | $1,452.00 | $2,046.01 | $8,965.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |