- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,795.64 / $12,765.09
| Facility | | $2,218.00 | $3,795.64 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.22 / $229.04 / $685.22
| Professional | | $138.22 | $229.04 | $685.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $172.26 / $348.36 / $1,623.00
| Facility | | $172.26 | $348.36 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $68.43 / $68.43 / $68.43
| Facility | AS | $68.43 | $68.43 | $68.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $222.26 / $330.36 / $422.56
| Facility | | $222.26 | $330.36 | $422.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |