- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,572.84 / $6,216.68 / $10,069.50
| Facility | | $1,572.84 | $6,216.68 | $10,069.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $629.00 / $15,735.00
| Facility | | $582.00 | $629.00 | $15,735.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $123.14 / $123.14 / $123.14
| Facility | AS | $123.14 | $123.14 | $123.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.34 / $1,363.83 / $1,897.50
| Professional | | $1,067.34 | $1,363.83 | $1,897.50 |
- 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 |