- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $323.59 / $14,454.40
| Facility | | $151.36 | $323.59 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,754.40 / $6,165.95 / $6,165.95
| Facility | | $5,754.40 | $6,165.95 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $467.74 / $741.31
| Facility | | $398.11 | $467.74 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $323.59 / $10,000.00
| Facility | | $158.49 | $323.59 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $346.74 / $11,220.18
| Facility | | $158.49 | $346.74 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $354.81 / $512.86
| Professional | | $229.09 | $354.81 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $407.38 / $1,288.25 / $1,288.25
| Facility | | $407.38 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $40.74 / $40.74 / $102.33
| Facility | AS | $40.74 | $40.74 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,309.57 / $10,232.93 / $12,589.25
| Facility | | $6,309.57 | $10,232.93 | $12,589.25 |