- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,820.52 / $2,034.43 / $10,267.50
| Facility | | $1,820.52 | $2,034.43 | $10,267.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $629.00 / $2,530.00
| Facility | | $582.00 | $629.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $143.09 / $143.09 / $143.09
| Facility | AS | $143.09 | $143.09 | $143.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,246.72 / $1,544.77 / $2,213.67
| Professional | | $1,246.72 | $1,544.77 | $2,213.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,541.00 / $2,139.00 / $6,125.00
| Facility | | $1,541.00 | $2,139.00 | $6,125.00 |