- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,388.44 / $6,760.83
| Facility | | $1,737.80 | $3,388.44 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,778.28 / $3,548.13
| Professional | | $977.24 | $1,778.28 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,862.09 / $3,388.44
| Facility | | $1,047.13 | $1,862.09 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $478.63 / $478.63 / $478.63
| Facility | AS | $478.63 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,398.83 / $2,818.38
| Professional | | $1,819.70 | $2,398.83 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $4,897.79 / $7,413.10
| Facility | | $1,318.26 | $4,897.79 | $7,413.10 |