- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $5,011.87 / $9,332.54
| Facility | | $199.53 | $5,011.87 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $12,589.25 / $16,218.10
| Facility | | $5,754.40 | $12,589.25 | $16,218.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $645.65 / $1,047.13
| Facility | | $562.34 | $645.65 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $436.52 / $6,918.31
| Facility | | $199.53 | $436.52 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $446.68 / $1,778.28
| Facility | | $199.53 | $446.68 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $489.78 / $724.44
| Professional | | $323.59 | $489.78 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $6,760.83 / $6,760.83
| Facility | | $2,818.38 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.23 / $56.23 / $363.08
| Facility | AS | $56.23 | $56.23 | $363.08 |
- 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 |