- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $7,943.28 / $16,595.87
| Facility | | $676.08 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $9,332.54 / $17,782.79
| Facility | | $2,238.72 | $9,332.54 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $1,000.00
| Facility | | $891.25 | $891.25 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,380.38
| Professional | | $1,071.52 | $1,071.52 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $831.76 / $1,380.38
| Facility | | $588.84 | $831.76 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $19,952.62 / $25,703.96
| Facility | | $4,677.35 | $19,952.62 | $25,703.96 |