- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.66 / $1,794.96 / $3,716.66
| Professional | | $1,035.66 | $1,794.96 | $3,716.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,710.26 / $2,676.08 / $6,608.00
| Facility | | $1,710.26 | $2,676.08 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $509.10 / $509.10 / $509.10
| Facility | AS | $509.10 | $509.10 | $509.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,672.84 / $2,506.56 / $3,278.42
| Facility | | $1,672.84 | $2,506.56 | $3,278.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |