- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $5,370.32 / $7,413.10
| Facility | | $977.24 | $5,370.32 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,754.23 / $6,025.60
| Facility | | $1,174.90 | $2,754.23 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $1,000.00 / $2,187.76
| Facility | | $912.01 | $1,000.00 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $91.20 / $91.20 / $91.20
| Facility | AS | $91.20 | $91.20 | $91.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $812.83 / $3,019.95
| Professional | | $575.44 | $812.83 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $21.38 / $21.38 / $21.38
| Professional | AS | $21.38 | $21.38 | $21.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,623.41 / $8,511.38
| Facility | | $1,513.56 | $5,623.41 | $8,511.38 |