- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,097.41 / $1,097.41 / $1,138.50
| Facility | | $1,097.41 | $1,097.41 | $1,138.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.00 / $1,966.73 / $3,323.11
| Facility | | $599.00 | $1,966.73 | $3,323.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.75 / $107.75 / $107.75
| Facility | AS | $107.75 | $107.75 | $107.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.75 / $1,167.19 / $1,780.23
| Professional | | $948.75 | $1,167.19 | $1,780.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.00 / $4,549.00 / $10,060.00
| Facility | | $2,460.00 | $4,549.00 | $10,060.00 |