- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,270.98 / $2,441.33 / $7,856.85
| Facility | | $1,270.98 | $2,441.33 | $7,856.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $818.00 / $3,559.00
| Facility | | $715.00 | $818.00 | $3,559.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.50 / $120.50 / $120.50
| Facility | AS | $120.50 | $120.50 | $120.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.15 / $1,345.72 / $1,814.91
| Professional | | $1,059.15 | $1,345.72 | $1,814.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.00 / $2,139.00 / $6,125.00
| Facility | | $1,541.00 | $2,139.00 | $6,125.00 |