- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.00 / $6,298.62 / $10,255.42
| Facility | | $5,012.00 | $6,298.62 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,539.25 / $2,439.03 / $4,113.29
| Professional | | $1,539.25 | $2,439.03 | $4,113.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.84 / $3,680.01 / $10,463.00
| Facility | | $2,132.84 | $3,680.01 | $10,463.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $764.78 / $764.78 / $764.78
| Facility | AS | $764.78 | $764.78 | $764.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,897.00 / $3,676.84 / $4,860.22
| Facility | | $2,897.00 | $3,676.84 | $4,860.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,542.00 / $12,871.00 / $16,293.00
| Facility | | $9,542.00 | $12,871.00 | $16,293.00 |