- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $6,606.93 / $8,128.31
| Facility | | $1,380.38 | $6,606.93 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,412.54 / $3,548.13
| Professional | | $851.14 | $1,412.54 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $7,762.47 / $14,791.08
| Facility | | $1,737.80 | $7,762.47 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,621.81 / $1,621.81 / $1,621.81
| Facility | AS | $1,621.81 | $1,621.81 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,344.23 / $3,548.13
| Professional | | $1,995.26 | $2,344.23 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,244.36 / $11,481.54 / $15,135.61
| Facility | | $7,244.36 | $11,481.54 | $15,135.61 |