- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,257.39 / $3,634.42 / $7,119.04
| Facility | | $2,257.39 | $3,634.42 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.15 / $682.85 / $1,500.59
| Professional | | $360.15 | $682.85 | $1,500.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.87 / $953.00 / $5,567.24
| Facility | | $563.87 | $953.00 | $5,567.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $165.01 / $165.01 / $165.01
| Facility | AS | $165.01 | $165.01 | $165.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.31 / $1,152.83 / $2,932.27
| Facility | | $793.31 | $1,152.83 | $2,932.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |