- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $5,370.32 / $7,943.28
| Facility | | $323.59 | $5,370.32 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $436.52 / $1,258.93
| Professional | | $199.53 | $436.52 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $562.34 / $6,606.93
| Facility | | $371.54 | $562.34 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Facility | AS | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $501.19 / $954.99
| Professional | | $457.09 | $501.19 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $7,413.10
| Facility | | $2,137.96 | $5,248.07 | $7,413.10 |