- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $2,570.40 / $7,585.78
| Facility | | $354.81 | $2,570.40 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $316.23 / $645.65
| Professional | | $204.17 | $316.23 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $3,981.07 / $4,466.84
| Facility | | $3,090.30 | $3,981.07 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $354.81 / $549.54
| Professional | | $223.87 | $354.81 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $1,513.56 / $2,511.89
| Professional | | $213.80 | $1,513.56 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $371.54 / $1,659.59
| Facility | | $371.54 | $371.54 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $37.15 / $37.15 / $37.15
| Facility | AS | $37.15 | $37.15 | $37.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $331.13 / $549.54
| Professional | | $213.80 | $331.13 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $436.52 / $512.86
| Professional | | $331.13 | $436.52 | $512.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $436.52 / $537.03
| Professional | | $436.52 | $436.52 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $323.59 / $524.81
| Facility | | $208.93 | $323.59 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $281.84 / $281.84
| Professional | | $281.84 | $281.84 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $309.03 / $4,073.80
| Facility | | $208.93 | $309.03 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $467.74 / $4,073.80
| Professional | | $323.59 | $467.74 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $3,467.37 / $5,754.40
| Facility | | $1,737.80 | $3,467.37 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $316.23 / $549.54
| Professional | | $190.55 | $316.23 | $549.54 |