- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $4,570.88 / $19,952.62
| Facility | | $1,737.80 | $4,570.88 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $3,019.95 / $23,988.33
| Facility | | $1,000.00 | $3,019.95 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $6,918.31 / $9,772.37
| Facility | | $2,511.89 | $6,918.31 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.96 / $165.96 / $165.96
| Facility | AS | $165.96 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $5,370.32
| Professional | | $1,000.00 | $1,445.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Professional | 80 | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $38.90 / $38.90 / $38.90
| Professional | AS | $38.90 | $38.90 | $38.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.83 / $1,513.56 / $3,235.94
| Facility | | $177.83 | $1,513.56 | $3,235.94 |