- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,018.00 / $5,503.00 / $10,651.00
| Facility | | $2,018.00 | $5,503.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,350.00 / $15,967.00 / $34,838.00
| Facility | | $9,350.00 | $15,967.00 | $34,838.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,702.90 / $6,702.90 / $21,114.49
| Facility | | $6,702.90 | $6,702.90 | $21,114.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $663.54 / $837.01 / $1,151.77
| Facility | | $663.54 | $837.01 | $1,151.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.67 / $952.61 / $1,313.94
| Professional | | $722.67 | $952.61 | $1,313.94 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $17.87 / $17.87 / $17.87
| Professional | AS | $17.87 | $17.87 | $17.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,251.00 / $11,924.00 / $19,712.00
| Facility | | $9,251.00 | $11,924.00 | $19,712.00 |