- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $964.94 / $9,826.41 / $24,756.33
| Facility | | $964.94 | $9,826.41 | $24,756.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.36 / $1,630.75 / $2,577.40
| Facility | | $1,269.36 | $1,630.75 | $2,577.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,483.55 / $2,497.03 / $10,876.46
| Facility | | $1,483.55 | $2,497.03 | $10,876.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.58 / $1,648.35 / $1,914.82
| Professional | | $1,207.58 | $1,648.35 | $1,914.82 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $364.83 / $364.83 / $364.83
| Professional | AS | $364.83 | $364.83 | $364.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,357.00 / $5,357.00 / $14,287.46
| Facility | | $5,357.00 | $5,357.00 | $14,287.46 |