- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $7,943.28 / $14,454.40
| Facility | | $380.19 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,398.83 / $4,677.35
| Facility | | $1,862.09 | $2,398.83 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $416.87 / $4,365.16
| Facility | | $199.53 | $416.87 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $102.33 / $102.33 / $102.33
| Facility | AS | $102.33 | $102.33 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $478.63 / $660.69
| Professional | | $457.09 | $478.63 | $660.69 |
- 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 |