- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.74 / $828.34 / $932.51
| Facility | | $35.74 | $828.34 | $932.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.00 / $1,772.93 / $2,985.38
| Facility | | $715.00 | $1,772.93 | $2,985.38 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $65.13 / $65.13 / $65.13
| Facility | AS | $65.13 | $65.13 | $65.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.77 / $733.28 / $1,021.39
| Professional | | $574.77 | $733.28 | $1,021.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,028.00 / $1,347.00 / $3,219.00
| Facility | | $1,028.00 | $1,347.00 | $3,219.00 |