- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.83 / $2,290.87 / $6,760.83
| Facility | | $0.83 | $2,290.87 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $169.82 / $295.12
| Facility | | $123.03 | $169.82 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $245.47 / $257.04
| Professional | | $234.42 | $245.47 | $257.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $181.97 / $204.17
| Professional | | $131.83 | $181.97 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $40.74 / $40.74 / $40.74
| Professional | AS | $40.74 | $40.74 | $40.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $812.83 / $812.83
| Facility | | $812.83 | $812.83 | $812.83 |