- 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
- $9,332.54 / $12,302.69 / $23,988.33
| Facility | | $9,332.54 | $12,302.69 | $23,988.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $363.08 / $4,365.16
| Facility | | $204.17 | $363.08 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $97.72 / $97.72 / $97.72
| Facility | AS | $97.72 | $97.72 | $97.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $489.78 / $676.08
| Professional | | $467.74 | $489.78 | $676.08 |
- 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 |