- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $5,888.44 / $10,000.00
| Facility | | $2,691.53 | $5,888.44 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $3,162.28 / $6,025.60
| Facility | | $1,230.27 | $3,162.28 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,511.89 / $20,417.38
| Facility | | $1,621.81 | $2,511.89 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $162.18 / $162.18 / $162.18
| Facility | AS | $162.18 | $162.18 | $162.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $5,370.32
| Professional | | $1,000.00 | $1,445.44 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Professional | 80 | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $38.02 / $38.02 / $38.02
| Professional | AS | $38.02 | $38.02 | $38.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $7,762.47 / $17,378.01
| Facility | | $1,995.26 | $7,762.47 | $17,378.01 |