- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,934.95 / $5,091.00 / $7,943.37
| Facility | | $1,934.95 | $5,091.00 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $775.59 / $1,307.10 / $2,191.28
| Professional | | $775.59 | $1,307.10 | $2,191.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.45 / $2,274.98 / $11,072.12
| Facility | | $1,500.45 | $2,274.98 | $11,072.12 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,196.53 / $1,196.53 / $1,196.53
| Facility | AS | $1,196.53 | $1,196.53 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.00 / $2,479.32 / $4,164.35
| Facility | | $1,411.00 | $2,479.32 | $4,164.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |