- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $7,943.28 / $14,454.40
| Facility | | $331.13 | $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
- $204.17 / $426.58 / $7,943.28
| Facility | | $204.17 | $426.58 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Facility | AS | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $537.03 / $575.44
| Professional | | $398.11 | $537.03 | $575.44 |
- 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 |