- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.62 / $4,278.00 / $10,503.27
| Facility | | $533.62 | $4,278.00 | $10,503.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,251.42 / $5,779.80 / $9,791.77
| Facility | | $2,251.42 | $5,779.80 | $9,791.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $375.23 / $709.00 / $5,565.61
| Facility | | $375.23 | $709.00 | $5,565.61 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.06 / $37.06 / $37.06
| Facility | AS | $37.06 | $37.06 | $37.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.74 / $559.61 / $2,159.62
| Professional | | $363.74 | $559.61 | $2,159.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $5,820.00 / $12,241.00
| Facility | | $1,300.00 | $5,820.00 | $12,241.00 |