- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $8,511.38 / $14,454.40
| Facility | | $436.52 | $8,511.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,882.50 / $16,595.87 / $32,359.37
| Facility | | $12,882.50 | $16,595.87 | $32,359.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.40 / $537.03 / $16,982.44
| Facility | | $288.40 | $537.03 | $16,982.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Facility | AS | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $588.84 / $794.33
| Professional | | $549.54 | $588.84 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,220.18 / $14,454.40 / $35,481.34
| Facility | | $11,220.18 | $14,454.40 | $35,481.34 |