- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.81 / $5,463.36 / $12,765.09
| Facility | | $2,163.81 | $5,463.36 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.99 / $1,024.52 / $2,030.66
| Professional | | $667.99 | $1,024.52 | $2,030.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $855.38 / $1,769.95 / $14,242.22
| Facility | | $855.38 | $1,769.95 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,478.67 / $2,478.67 / $2,478.67
| Facility | AS | $2,478.67 | $2,478.67 | $2,478.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,777.48 / $8,697.79
| Facility | | $1,089.00 | $1,777.48 | $8,697.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,234.00 / $9,346.00 / $14,242.22
| Facility | | $7,234.00 | $9,346.00 | $14,242.22 |