- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $275.42 / $7,943.28 / $14,454.40
| Facility | | $275.42 | $7,943.28 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,791.08 / $19,498.45 / $38,018.94
| Facility | | $14,791.08 | $19,498.45 | $38,018.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $234.42 / $707.95
| Facility | | $138.04 | $234.42 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.79 / $70.79 / $70.79
| Facility | AS | $70.79 | $70.79 | $70.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $354.81 / $489.78
| Professional | | $288.40 | $354.81 | $489.78 |
- 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 |