- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,404.01 / $1,732.48 / $17,312.18
| Facility | | $1,404.01 | $1,732.48 | $17,312.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,136.00 / $3,018.07 / $4,939.00
| Facility | | $1,136.00 | $3,018.07 | $4,939.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.97 / $132.97 / $132.97
| Facility | AS | $132.97 | $132.97 | $132.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,170.01 / $1,486.75 / $2,094.23
| Professional | | $1,170.01 | $1,486.75 | $2,094.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $1,773.00 / $3,590.00
| Facility | | $1,236.00 | $1,773.00 | $3,590.00 |