- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,298.62 / $11,100.08
| Facility | | $4,964.00 | $6,298.62 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,467.86 / $2,363.58 / $4,408.66
| Professional | | $1,467.86 | $2,363.58 | $4,408.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,953.87 / $3,237.37 / $4,898.00
| Facility | | $1,953.87 | $3,237.37 | $4,898.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $720.28 / $720.28 / $720.28
| Facility | AS | $720.28 | $720.28 | $720.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,401.63 / $3,462.86 / $4,928.62
| Facility | | $2,401.63 | $3,462.86 | $4,928.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |