- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $7,943.28 / $14,454.40
| Facility | | $309.03 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33,884.42 / $43,651.58 / $85,113.80
| Facility | | $33,884.42 | $43,651.58 | $85,113.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.55 / $281.84 / $7,943.28
| Facility | | $190.55 | $281.84 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $77.62 / $77.62 / $77.62
| Facility | AS | $77.62 | $77.62 | $77.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $389.05 / $524.81
| Professional | | $371.54 | $389.05 | $524.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $4,570.88 / $13,803.84
| Facility | | $3,235.94 | $4,570.88 | $13,803.84 |