- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.57 / $4,268.08 / $7,403.28
| Facility | | $468.57 | $4,268.08 | $7,403.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.00 / $2,700.46 / $3,837.49
| Facility | | $509.00 | $2,700.46 | $3,837.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.06 / $37.06 / $37.06
| Facility | AS | $37.06 | $37.06 | $37.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.25 / $419.15 / $581.33
| Professional | | $327.25 | $419.15 | $581.33 |
- 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 |