- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,414.00 / $5,041.00 / $10,119.64
| Facility | | $1,414.00 | $5,041.00 | $10,119.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,350.00 / $15,967.00 / $34,838.00
| Facility | | $9,350.00 | $15,967.00 | $34,838.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,966.25 / $6,966.25 / $21,944.08
| Facility | | $6,966.25 | $6,966.25 | $21,944.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $781.03 / $1,087.16 / $1,405.85
| Facility | | $781.03 | $1,087.16 | $1,405.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.63 / $1,121.29 / $1,546.60
| Professional | | $850.63 | $1,121.29 | $1,546.60 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $21.03 / $21.03 / $21.03
| Professional | AS | $21.03 | $21.03 | $21.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,251.00 / $11,924.00 / $19,712.00
| Facility | | $9,251.00 | $11,924.00 | $19,712.00 |