- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.96 / $346.74 / $14,454.40
| Facility | | $165.96 | $346.74 | $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
- $436.52 / $512.86 / $812.83
| Facility | | $436.52 | $512.86 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $354.81 / $10,000.00
| Facility | | $173.78 | $354.81 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $389.05 / $11,220.18
| Facility | | $173.78 | $389.05 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $389.05 / $575.44
| Professional | | $251.19 | $389.05 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $1,288.25 / $1,288.25
| Facility | | $436.52 | $1,288.25 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $43.65 / $43.65 / $112.20
| Facility | AS | $43.65 | $43.65 | $112.20 |
- 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 |