- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $154.88 / $676.08 / $8,317.64
| Facility | | $154.88 | $676.08 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,630.78 / $3,630.78 / $3,715.35
| Facility | | $3,630.78 | $3,630.78 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $602.56 / $602.56 / $602.56
| Facility | | $602.56 | $602.56 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $204.17 / $234.42
| Professional | | $204.17 | $204.17 | $234.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $138.04 / $229.09
| Facility | | $100.00 | $138.04 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $758.58 / $1,949.84
| Facility | | $173.78 | $758.58 | $1,949.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $45,708.82
| Facility | | $3,467.37 | $3,467.37 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.66 / $61.66 / $61.66
| Facility | AS | $61.66 | $61.66 | $61.66 |