- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.97 / $5,045.00 / $6,915.00
| Facility | | $595.97 | $5,045.00 | $6,915.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.01 / $3,514.57 / $6,339.18
| Facility | | $1,206.01 | $3,514.57 | $6,339.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,142.94 / $1,230.75 / $1,890.08
| Facility | | $1,142.94 | $1,230.75 | $1,890.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,456.05 / $2,456.05 / $2,456.05
| Facility | | $2,456.05 | $2,456.05 | $2,456.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.72 / $838.21 / $2,556.56
| Professional | | $598.72 | $838.21 | $2,556.56 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $47.36 / $47.36 / $47.36
| Professional | AS | $47.36 | $47.36 | $47.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,519.00 / $6,351.00 / $8,836.00
| Facility | | $1,519.00 | $6,351.00 | $8,836.00 |