- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.95 / $851.14 / $2,041.74
| Facility | | $0.95 | $851.14 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,168.69 / $6,165.95 / $7,585.78
| Facility | | $4,168.69 | $6,165.95 | $7,585.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $691.83 / $1,096.48
| Facility | | $588.84 | $691.83 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $6,918.31 / $13,489.63
| Facility | | $234.42 | $6,918.31 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $1,202.26 / $2,041.74
| Facility | | $234.42 | $1,202.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $537.03 / $812.83
| Professional | | $269.15 | $537.03 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $3,890.45 / $3,890.45
| Facility | | $588.84 | $3,890.45 | $3,890.45 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $58.88 / $58.88 / $147.91
| Facility | AS | $58.88 | $58.88 | $147.91 |
- 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 |