- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $501.19 / $14,454.40
| Facility | | $263.03 | $501.19 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $8,709.64 / $11,220.18
| Facility | | $4,786.30 | $8,709.64 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $741.31 / $1,174.90
| Facility | | $630.96 | $741.31 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $4,786.30 / $8,912.51
| Facility | | $269.15 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $1,202.26 / $1,778.28
| Facility | | $269.15 | $1,202.26 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $549.54 / $794.33
| Professional | | $281.84 | $549.54 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,890.45 / $3,890.45
| Facility | | $630.96 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.10 / $63.10 / $154.88
| Facility | AS | $63.10 | $63.10 | $154.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,584.89 / $2,137.96
| Facility | | $1,023.29 | $1,584.89 | $2,137.96 |