- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $5,011.87 / $7,943.28
| Facility | | $1,000.00 | $5,011.87 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,737.80 / $3,801.89
| Professional | | $1,000.00 | $1,737.80 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,995.26 / $3,388.44
| Facility | | $1,071.52 | $1,995.26 | $3,388.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $489.78 / $489.78 / $489.78
| Facility | AS | $489.78 | $489.78 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,511.89 / $2,884.03
| Professional | | $1,862.09 | $2,511.89 | $2,884.03 |
- 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 |