- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,018.00 / $5,503.00 / $10,651.00
| Facility | | $2,018.00 | $5,503.00 | $10,651.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,999.00 / $26,120.00 / $67,429.00
| Facility | | $15,999.00 | $26,120.00 | $67,429.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,332.81 / $20,332.81 / $50,000.00
| Facility | | $20,332.81 | $20,332.81 | $50,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,235.76 / $1,711.81 / $2,182.80
| Facility | | $1,235.76 | $1,711.81 | $2,182.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,345.87 / $1,774.10 / $2,447.04
| Professional | | $1,345.87 | $1,774.10 | $2,447.04 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $33.28 / $33.28 / $33.28
| Professional | AS | $33.28 | $33.28 | $33.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,146.00 / $13,967.00 / $20,534.00
| Facility | | $11,146.00 | $13,967.00 | $20,534.00 |