- 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
- $767.18 / $1,223.11 / $2,848.18
| Professional | | $767.18 | $1,223.11 | $2,848.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,232.44 / $2,035.05 / $12,342.67
| Facility | | $1,232.44 | $2,035.05 | $12,342.67 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,887.52 / $1,887.52 / $1,887.52
| Facility | AS | $1,887.52 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.73 / $2,035.05 / $6,616.19
| Facility | | $1,522.73 | $2,035.05 | $6,616.19 |
- 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 |