- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.98 / $1,680.19 / $9,574.42
| Facility | | $0.98 | $1,680.19 | $9,574.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $582.00 / $715.00 / $2,530.00
| Facility | | $582.00 | $715.00 | $2,530.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.72 / $154.72 / $154.72
| Facility | AS | $154.72 | $154.72 | $154.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,360.11 / $1,727.09 / $2,322.88
| Professional | | $1,360.11 | $1,727.09 | $2,322.88 |
- 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 |