- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $724.44 / $7,943.28 / $14,454.40
| Facility | | $724.44 | $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
- $446.68 / $676.08 / $7,943.28
| Facility | | $446.68 | $676.08 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.97 / $181.97 / $181.97
| Facility | AS | $181.97 | $181.97 | $181.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $912.01 / $1,258.93
| Professional | | $870.96 | $912.01 | $1,258.93 |
- 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 |