- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $9,120.11 / $16,595.87
| Facility | | $371.54 | $9,120.11 | $16,595.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $11,481.54 / $20,417.38
| Facility | | $6,456.54 | $11,481.54 | $20,417.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $14,791.08 / $15,488.17
| Facility | | $575.44 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $22.91 / $22.91 / $22.91
| Facility | AS | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $323.59
| Professional | | $263.03 | $263.03 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.90 / $194.98 / $316.23
| Facility | | $134.90 | $194.98 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,202.26 / $3,548.13
| Facility | | $354.81 | $1,202.26 | $3,548.13 |