- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $4,897.79 / $16,595.87
| Facility | | $1,148.15 | $4,897.79 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,025.60 / $11,481.54
| Facility | | $2,570.40 | $6,025.60 | $11,481.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,230.27
| Facility | | $371.54 | $575.44 | $1,230.27 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.03 / $123.03 / $123.03
| Facility | AS | $123.03 | $123.03 | $123.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,230.27 / $1,737.80
| Professional | | $1,230.27 | $1,230.27 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $977.24 / $1,584.89
| Facility | | $724.44 | $977.24 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,182.57 / $23,442.29
| Facility | | $2,344.23 | $13,182.57 | $23,442.29 |