- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,294.32 / $4,917.20 / $7,119.04
| Facility | | $2,294.32 | $4,917.20 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $714.16 / $1,139.42 / $2,441.66
| Professional | | $714.16 | $1,139.42 | $2,441.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,207.54 / $1,891.03 / $14,242.22
| Facility | | $1,207.54 | $1,891.03 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $2,455.55 / $2,455.55 / $2,455.55
| Facility | AS | $2,455.55 | $2,455.55 | $2,455.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,409.51 / $1,882.56 / $8,546.66
| Facility | | $1,409.51 | $1,882.56 | $8,546.66 |
- 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 |