- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $7,943.28 / $16,595.87
| Facility | | $758.58 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,000.00 / $19,952.62
| Facility | | $4,073.80 | $10,000.00 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $831.76 / $5,754.40
| Facility | | $575.44 | $831.76 | $5,754.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $83.18 / $83.18 / $83.18
| Facility | AS | $83.18 | $83.18 | $83.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,548.82
| Professional | | $1,000.00 | $1,000.00 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $776.25 / $1,318.26
| Facility | | $524.81 | $776.25 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |