- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,780.09 / $5,463.36 / $12,040.85
| Facility | | $1,780.09 | $5,463.36 | $12,040.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.27 / $1,096.94 / $2,518.48
| Professional | | $689.27 | $1,096.94 | $2,518.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.63 / $1,834.80 / $12,342.67
| Facility | | $1,175.63 | $1,834.80 | $12,342.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,474.92 / $2,474.92 / $2,474.92
| Facility | AS | $2,474.92 | $2,474.92 | $2,474.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,373.59 / $1,834.80 / $8,655.17
| Facility | | $1,373.59 | $1,834.80 | $8,655.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,581.44 / $7,581.44 / $7,581.44
| Facility | | $7,581.44 | $7,581.44 | $7,581.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,060.00 / $11,869.99
| Facility | | $7,221.00 | $8,060.00 | $11,869.99 |