- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,380.38 / $10,471.29
| Facility | | $575.44 | $1,380.38 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $4,365.16 / $4,466.84
| Facility | | $4,365.16 | $4,365.16 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,380.38
| Professional | | $1,000.00 | $1,000.00 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $794.33 / $1,258.93
| Facility | | $588.84 | $794.33 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,981.07 / $14,791.08 / $22,908.68
| Facility | | $3,981.07 | $14,791.08 | $22,908.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $45,708.82
| Facility | | $8,912.51 | $8,912.51 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | AS | $891.25 | $891.25 | $891.25 |