- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.34 / $2,900.00 / $8,374.42
| Facility | | $818.34 | $2,900.00 | $8,374.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $21,429.36 / $21,429.36 / $21,429.36
| Facility | AS | $21,429.36 | $21,429.36 | $21,429.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,667.96 / $10,202.07 / $17,837.98
| Facility | | $7,667.96 | $10,202.07 | $17,837.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.00 / $6,831.39 / $7,626.43
| Facility | | $709.00 | $6,831.39 | $7,626.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $809.22 / $1,248.83 / $3,354.50
| Professional | | $809.22 | $1,248.83 | $3,354.50 |
- 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
- $2,100.00 / $5,820.00 / $12,241.00
| Facility | | $2,100.00 | $5,820.00 | $12,241.00 |