- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.37 / $4,698.52 / $9,069.08
| Facility | | $969.37 | $4,698.52 | $9,069.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $629.00 / $686.68 / $3,125.00
| Facility | | $629.00 | $686.68 | $3,125.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $67.78 / $67.78 / $67.78
| Facility | AS | $67.78 | $67.78 | $67.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.65 / $761.47 / $1,019.68
| Professional | | $596.65 | $761.47 | $1,019.68 |
- 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 |