- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,227.00 / $5,463.36 / $7,120.36
| Facility | | $4,227.00 | $5,463.36 | $7,120.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,932.00 / $1,932.00 / $1,932.00
| Facility | | $1,932.00 | $1,932.00 | $1,932.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.73 / $943.60 / $2,034.76
| Professional | | $588.73 | $943.60 | $2,034.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.24 / $1,522.07 / $7,915.44
| Facility | | $883.24 | $1,522.07 | $7,915.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $905.99 / $905.99 / $905.99
| Facility | AS | $905.99 | $905.99 | $905.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,706.61 / $3,162.53
| Facility | | $1,000.00 | $1,706.61 | $3,162.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,484.10 / $7,091.00 / $10,606.69
| Facility | | $4,484.10 | $7,091.00 | $10,606.69 |