- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $4,365.16 / $10,471.29
| Facility | | $616.60 | $4,365.16 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $1,023.29 / $2,511.89
| Professional | | $691.83 | $1,023.29 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,949.84 / $31,622.78
| Facility | | $1,148.15 | $1,949.84 | $31,622.78 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Facility | AS | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $1,778.28 / $1,949.84
| Professional | | $1,621.81 | $1,778.28 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $13,489.63 / $34,673.69
| Facility | | $8,511.38 | $13,489.63 | $34,673.69 |