- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.28 / $2,000.10 / $4,602.64
| Professional | | $1,160.28 | $2,000.10 | $4,602.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,937.34 / $3,181.97 / $26,648.02
| Facility | | $1,937.34 | $3,181.97 | $26,648.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $7,632.03 / $7,632.03 / $7,632.03
| Facility | AS | $7,632.03 | $7,632.03 | $7,632.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,254.75 / $3,181.97 / $25,628.73
| Facility | | $2,254.75 | $3,181.97 | $25,628.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |