- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.11 / $800.98 / $800.98
| Facility | | $580.11 | $800.98 | $800.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $817.37 / $1,132.71 / $1,836.46
| Facility | | $817.37 | $1,132.71 | $1,836.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,282.39 / $1,718.33 / $11,238.10
| Facility | | $1,282.39 | $1,718.33 | $11,238.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $798.04 / $1,139.83 / $1,527.33
| Professional | | $798.04 | $1,139.83 | $1,527.33 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $291.86 / $291.86 / $291.86
| Professional | AS | $291.86 | $291.86 | $291.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,714.00 / $2,714.00 / $2,714.00
| Facility | | $2,714.00 | $2,714.00 | $2,714.00 |