- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $7,943.28 / $16,595.87
| Facility | | $2,089.30 | $7,943.28 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,187.76 / $2,951.21
| Facility | | $1,819.70 | $2,187.76 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $14,791.08 / $15,488.17
| Facility | | $2,344.23 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $309.03 / $309.03 / $309.03
| Facility | AS | $309.03 | $309.03 | $309.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $2,884.03 / $4,168.69
| Professional | | $2,884.03 | $2,884.03 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,344.23 / $3,981.07
| Facility | | $1,737.80 | $2,344.23 | $3,981.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $6,760.83 / $9,120.11
| Facility | | $1,479.11 | $6,760.83 | $9,120.11 |