- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,989.00 / $10,205.00 / $25,346.00
| Facility | | $2,989.00 | $10,205.00 | $25,346.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,178.00 / $26,120.00 / $59,050.00
| Facility | | $16,178.00 | $26,120.00 | $59,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,059.90 / $20,059.90 / $50,000.00
| Facility | | $20,059.90 | $20,059.90 | $50,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,608.70 / $2,150.23 / $2,895.66
| Facility | | $1,608.70 | $2,150.23 | $2,895.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,752.05 / $2,389.16 / $3,185.54
| Professional | | $1,752.05 | $2,389.16 | $3,185.54 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $43.32 / $43.32 / $43.32
| Professional | AS | $43.32 | $43.32 | $43.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,284.00 / $18,481.00 / $30,421.00
| Facility | | $7,284.00 | $18,481.00 | $30,421.00 |