- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $338.84 / $14,454.40
| Facility | | $151.36 | $338.84 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $4,786.30 / $7,413.10
| Facility | | $3,162.28 | $4,786.30 | $7,413.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $501.19 / $794.33
| Facility | | $426.58 | $501.19 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $331.13 / $10,000.00
| Facility | | $162.18 | $331.13 | $10,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.18 / $338.84 / $7,585.78
| Facility | | $162.18 | $338.84 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $549.54
| Professional | | $245.47 | $380.19 | $549.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $2,754.23 / $2,754.23
| Facility | | $426.58 | $2,754.23 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $42.66 / $42.66 / $275.42
| Facility | AS | $42.66 | $42.66 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $6,165.95 / $19,498.45
| Facility | | $2,290.87 | $6,165.95 | $19,498.45 |