- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.21 / $3,801.89 / $12,589.25
| Facility | | $186.21 | $3,801.89 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,762.47 / $10,232.93 / $19,952.62
| Facility | | $7,762.47 | $10,232.93 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $263.03 / $5,370.32
| Facility | | $144.54 | $263.03 | $5,370.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.74 / $75.86 / $75.86
| Facility | AS | $40.74 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $371.54 / $512.86
| Professional | | $302.00 | $371.54 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $6,606.93 / $9,120.11
| Facility | | $4,677.35 | $6,606.93 | $9,120.11 |