- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $9,120.11 / $18,197.01
| Facility | | $512.86 | $9,120.11 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $10,715.19 / $19,952.62
| Facility | | $4,073.80 | $10,715.19 | $19,952.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $14,791.08 / $15,488.17
| Facility | | $398.11 | $14,791.08 | $15,488.17 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $39.81 / $39.81 / $39.81
| Facility | AS | $39.81 | $39.81 | $39.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $436.52
| Professional | | $371.54 | $371.54 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.98 / $281.84 / $467.74
| Facility | | $194.98 | $281.84 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $1,737.80 / $18,197.01
| Facility | | $354.81 | $1,737.80 | $18,197.01 |