- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.37 / $619.66 / $3,452.15
| Facility | | $552.37 | $619.66 | $3,452.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.76 / $3,016.21 / $3,016.21
| Facility | | $440.76 | $3,016.21 | $3,016.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.36 / $43.36 / $43.36
| Facility | AS | $43.36 | $43.36 | $43.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.17 / $447.10 / $636.58
| Professional | | $342.17 | $447.10 | $636.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,236.00 / $1,236.00 / $1,560.00
| Facility | | $1,236.00 | $1,236.00 | $1,560.00 |