- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,288.25 / $1,905.46 / $4,897.79
| Professional | | $1,288.25 | $1,905.46 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $194.98 / $380.19 / $676.08
| Professional | AS | $194.98 | $380.19 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $2,290.87 / $5,128.61
| Professional | | $2,290.87 | $2,290.87 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,995.26 / $3,235.94
| Professional | | $1,071.52 | $1,995.26 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $2,041.74 / $2,344.23
| Professional | | $1,513.56 | $2,041.74 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,041.74 / $3,467.37
| Professional | | $1,659.59 | $2,041.74 | $3,467.37 |