- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,884.68 / $4,604.83 / $7,119.04
| Facility | | $1,884.68 | $4,604.83 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.46 / $924.09 / $2,151.69
| Professional | | $581.46 | $924.09 | $2,151.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.44 / $1,550.78 / $14,242.22
| Facility | | $981.44 | $1,550.78 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,380.48 / $2,380.48 / $2,380.48
| Facility | AS | $2,380.48 | $2,380.48 | $2,380.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,157.00 / $1,550.78 / $8,303.62
| Facility | | $1,157.00 | $1,550.78 | $8,303.62 |
- 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 |