- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $872.43 / $872.43 / $4,338.00
| Facility | | $872.43 | $872.43 | $4,338.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,072.52 / $1,431.35 / $2,412.13
| Facility | | $1,072.52 | $1,431.35 | $2,412.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.30 / $2,373.71 / $2,981.46
| Facility | | $1,391.30 | $2,373.71 | $2,981.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.46 / $1,594.71 / $1,876.01
| Professional | | $1,152.46 | $1,594.71 | $1,876.01 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $350.80 / $350.80 / $350.80
| Professional | AS | $350.80 | $350.80 | $350.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,143.00 / $3,143.00 / $3,143.00
| Facility | | $3,143.00 | $3,143.00 | $3,143.00 |