- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,674.00 / $5,503.00 / $10,651.00
| Facility | | $1,674.00 | $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
- $6,633.47 / $6,633.47 / $20,895.80
| Facility | | $6,633.47 | $6,633.47 | $20,895.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.00 / $1,501.35 / $1,895.04
| Facility | | $1,128.00 | $1,501.35 | $1,895.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.51 / $1,619.40 / $2,233.66
| Professional | | $1,228.51 | $1,619.40 | $2,233.66 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $30.38 / $30.38 / $30.38
| Professional | AS | $30.38 | $30.38 | $30.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,146.00 / $13,967.00 / $20,534.00
| Facility | | $11,146.00 | $13,967.00 | $20,534.00 |