- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $4,786.30 / $7,079.46
| Facility | | $794.33 | $4,786.30 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $707.95 / $1,698.24
| Professional | | $467.74 | $707.95 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $1,348.96 / $17,782.79
| Facility | | $758.58 | $1,348.96 | $17,782.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,905.46 / $1,905.46 / $1,905.46
| Facility | AS | $1,905.46 | $1,905.46 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,174.90 / $1,348.96
| Professional | | $1,023.29 | $1,174.90 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.41 / $9,549.93 / $19,498.45
| Facility | | $5,495.41 | $9,549.93 | $19,498.45 |