- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.69 / $2,373.00 / $6,298.62
| Facility | | $591.69 | $2,373.00 | $6,298.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.20 / $353.38 / $1,396.90
| Professional | | $214.20 | $353.38 | $1,396.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.89 / $537.01 / $1,623.00
| Facility | | $294.89 | $537.01 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $105.52 / $105.52 / $105.52
| Facility | AS | $105.52 | $105.52 | $105.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.46 / $506.66 / $653.25
| Facility | | $337.46 | $506.66 | $653.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |