- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.48 / $831.76 / $912.01
| Facility | | $35.48 | $831.76 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,584.89 / $1,819.70
| Facility | | $707.95 | $1,584.89 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | AS | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $645.65 / $933.25
| Professional | | $489.78 | $645.65 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,445.44 / $3,235.94
| Facility | | $1,023.29 | $1,445.44 | $3,235.94 |