- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $3,467.37 / $9,549.93
| Facility | | $602.56 | $3,467.37 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $630.96 / $1,819.70
| Professional | | $257.04 | $630.96 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,754.40 / $13,803.84
| Facility | | $1,995.26 | $5,754.40 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $812.83 / $1,737.80
| Professional | | $302.00 | $812.83 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $2,951.21 / $17,378.01
| Facility | | $436.52 | $2,951.21 | $17,378.01 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.65 / $43.65 / $43.65
| Facility | AS | $43.65 | $43.65 | $43.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $794.33 / $2,089.30
| Professional | | $309.03 | $794.33 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $5,623.41 / $12,882.50
| Facility | | $1,995.26 | $5,623.41 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $724.44 / $1,584.89
| Professional | | $275.42 | $724.44 | $1,584.89 |