- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $416.87 / $14,454.40
| Facility | | $208.93 | $416.87 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $7,943.28 / $12,589.25
| Facility | | $5,011.87 | $7,943.28 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $602.56 / $977.24
| Facility | | $524.81 | $602.56 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $7,244.36 / $13,489.63
| Facility | | $208.93 | $7,244.36 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $2,818.38 / $9,549.93
| Facility | | $208.93 | $2,818.38 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $489.78 / $831.76
| Professional | | $251.19 | $489.78 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,318.26 / $1,318.26
| Facility | | $524.81 | $1,318.26 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $52.48 / $52.48 / $131.83
| Facility | AS | $52.48 | $52.48 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |