- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,034.31 / $4,604.83 / $7,119.04
| Facility | | $2,034.31 | $4,604.83 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.66 / $1,114.55 / $3,047.57
| Professional | | $646.66 | $1,114.55 | $3,047.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,070.69 / $1,767.10 / $14,242.22
| Facility | | $1,070.69 | $1,767.10 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,581.44 / $2,581.44 / $2,581.44
| Facility | AS | $2,581.44 | $2,581.44 | $2,581.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,252.15 / $1,778.64 / $8,642.79
| Facility | | $1,252.15 | $1,778.64 | $8,642.79 |
- 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 |