- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,551.00 / $6,886.00 / $10,651.00
| Facility | | $2,551.00 | $6,886.00 | $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
- $6,615.25 / $6,615.25 / $20,838.41
| Facility | | $6,615.25 | $6,615.25 | $20,838.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $754.57 / $910.09 / $1,295.58
| Facility | | $754.57 | $910.09 | $1,295.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $830.03 / $1,094.13 / $1,509.14
| Professional | | $830.03 | $1,094.13 | $1,509.14 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $20.52 / $20.52 / $20.52
| Professional | AS | $20.52 | $20.52 | $20.52 |
- 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 |