- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,397.26 / $7,047.77 / $14,955.56
| Facility | | $4,397.26 | $7,047.77 | $14,955.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.00 / $2,754.30 / $3,914.00
| Facility | | $509.00 | $2,754.30 | $3,914.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $47.01 / $47.01 / $47.01
| Facility | AS | $47.01 | $47.01 | $47.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.05 / $528.40 / $824.06
| Professional | | $413.05 | $528.40 | $824.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $1,679.00 / $3,590.00
| Facility | | $1,236.00 | $1,679.00 | $3,590.00 |