- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,906.97 / $5,463.36 / $7,943.37
| Facility | | $3,906.97 | $5,463.36 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.77 / $1,112.74 / $2,135.80
| Professional | | $724.77 | $1,112.74 | $2,135.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.00 / $1,899.36 / $14,242.22
| Facility | | $825.00 | $1,899.36 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,446.92 / $2,446.92 / $2,446.92
| Facility | AS | $2,446.92 | $2,446.92 | $2,446.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.02 / $1,925.20 / $8,283.12
| Facility | | $1,327.02 | $1,925.20 | $8,283.12 |
- 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 |