- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,000.00 / $20,892.96
| Facility | | $4,073.80 | $10,000.00 | $20,892.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,220.18 / $17,782.79
| Facility | | $6,456.54 | $11,220.18 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $61.66 / $100.00 / $8,128.31
| Facility | | $61.66 | $100.00 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,258.93 / $1,698.24
| Professional | | $851.14 | $1,258.93 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,380.38 / $2,691.53
| Professional | | $1,047.13 | $1,380.38 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $56.23 / $9,772.37
| Facility | | $54.95 | $56.23 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $977.24 / $977.24 / $977.24
| Facility | AS | $977.24 | $977.24 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $2,398.83
| Facility | | $1,174.90 | $1,513.56 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $14,125.38 / $28,840.32
| Facility | | $7,762.47 | $14,125.38 | $28,840.32 |