- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,623.41 / $10,964.78
| Facility | | $2,137.96 | $5,623.41 | $10,964.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $6,025.60 / $12,302.69
| Facility | | $2,238.72 | $6,025.60 | $12,302.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $2,691.53 / $58,884.37
| Facility | | $501.19 | $2,691.53 | $58,884.37 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $269.15 / $269.15
| Facility | AS | $269.15 | $269.15 | $269.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,454.71 / $8,511.38
| Professional | | $1,737.80 | $2,454.71 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $72.44 / $72.44 / $72.44
| Professional | AS | $72.44 | $72.44 | $72.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $8,912.51 / $19,498.45
| Facility | | $2,290.87 | $8,912.51 | $19,498.45 |