- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $5,888.44 / $10,964.78
| Facility | | $1,202.26 | $5,888.44 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,715.35 / $6,025.60
| Facility | | $1,348.96 | $3,715.35 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,862.09 / $2,818.38
| Facility | | $1,380.38 | $1,862.09 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Facility | AS | $138.04 | $138.04 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,230.27 / $4,677.35
| Professional | | $891.25 | $1,230.27 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $33.11 / $33.11 / $33.11
| Professional | AS | $33.11 | $33.11 | $33.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.56 / $5,623.41 / $8,511.38
| Facility | | $1,513.56 | $5,623.41 | $8,511.38 |