- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $2,691.53 / $5,128.61
| Facility | | $263.03 | $2,691.53 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $1,000.00
| Professional | | $190.55 | $309.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,630.78 / $28,840.32
| Facility | | $524.81 | $3,630.78 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | AS | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $954.99
| Professional | | $234.42 | $407.38 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $575.44
| Facility | | $251.19 | $251.19 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $870.96
| Professional | | $234.42 | $407.38 | $870.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $416.87 / $7,079.46
| Facility | | $199.53 | $416.87 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $489.78 / $707.95
| Professional | | $380.19 | $489.78 | $707.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,630.78 / $8,511.38
| Facility | | $1,698.24 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $436.52 / $933.25
| Professional | | $239.88 | $436.52 | $933.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,202.26 / $3,235.94
| Facility | | $1,202.26 | $1,202.26 | $3,235.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $3,630.78 / $28,840.32
| Facility | | $524.81 | $3,630.78 | $28,840.32 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | AS | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $407.38 / $1,000.00
| Professional | | $234.42 | $407.38 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,548.13 / $8,511.38
| Facility | | $1,096.48 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $426.58 / $831.76
| Professional | | $239.88 | $426.58 | $831.76 |