- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,659.59 / $7,943.28 / $22,387.21
| Facility | | $1,659.59 | $7,943.28 | $22,387.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $9,772.37 / $19,952.62
| Facility | | $3,090.30 | $9,772.37 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $776.25 / $5,754.40
| Facility | | $501.19 | $776.25 | $5,754.40 |
- 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
- $1,148.15 / $1,148.15 / $1,905.46
| Professional | | $1,148.15 | $1,148.15 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $933.25 / $1,584.89
| Facility | | $630.96 | $933.25 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,677.35 / $20,417.38 / $25,703.96
| Facility | | $4,677.35 | $20,417.38 | $25,703.96 |