- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $9,120.11 / $18,197.01
| Facility | | $2,089.30 | $9,120.11 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $14,454.40 / $26,302.68
| Facility | | $6,025.60 | $14,454.40 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,258.93 / $1,348.96
| Facility | | $812.83 | $1,258.93 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $134.90 / $134.90 / $134.90
| Facility | AS | $134.90 | $134.90 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $977.24 / $1,819.70
| Professional | | $977.24 | $977.24 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $977.24 / $1,698.24
| Facility | | $724.44 | $977.24 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |