- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $6,025.60 / $9,772.37
| Facility | | $588.84 | $6,025.60 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,570.88 / $8,912.51
| Facility | | $1,995.26 | $4,570.88 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $2,570.40
| Facility | | $501.19 | $602.56 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $60.26 / $60.26 / $60.26
| Facility | AS | $60.26 | $60.26 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $707.95 / $1,230.27
| Professional | | $707.95 | $707.95 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,000.00
| Facility | | $371.54 | $575.44 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $11,220.18 / $16,982.44
| Facility | | $1,995.26 | $11,220.18 | $16,982.44 |