- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.39 / $3,598.73 / $7,119.04
| Facility | | $1,202.39 | $3,598.73 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.74 / $613.54 / $1,396.28
| Professional | | $357.74 | $613.54 | $1,396.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $445.72 / $825.69 / $5,275.65
| Facility | | $445.72 | $825.69 | $5,275.65 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.30 / $1,537.78 / $1,537.78
| Facility | AS | $95.30 | $1,537.78 | $1,537.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $626.00 / $928.82 / $5,090.60
| Facility | | $626.00 | $928.82 | $5,090.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $11,732.00 / $13,238.00
| Facility | | $7,221.00 | $11,732.00 | $13,238.00 |