- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.94 / $1,845.24 / $3,693.00
| Facility | | $369.94 | $1,845.24 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.25 / $340.43 / $684.42
| Professional | | $212.25 | $340.43 | $684.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.40 / $1,052.09 / $3,445.00
| Facility | | $604.40 | $1,052.09 | $3,445.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $127.70 / $127.70 / $127.70
| Facility | AS | $127.70 | $127.70 | $127.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $277.32 / $578.21 / $1,884.56
| Professional | | $277.32 | $578.21 | $1,884.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $299.72 / $389.64 / $687.56
| Facility | | $299.72 | $389.64 | $687.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.02 / $514.55 / $1,085.34
| Professional | | $291.02 | $514.55 | $1,085.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $261.24 / $546.52 / $6,679.00
| Facility | | $261.24 | $546.52 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.43 / $542.91 / $749.43
| Professional | | $432.43 | $542.91 | $749.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.89 / $671.25 / $1,068.49
| Professional | | $319.89 | $671.25 | $1,068.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.99 / $838.52 / $982.93
| Facility | | $727.99 | $838.52 | $982.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $291.41 / $291.41 / $774.25
| Professional | | $291.41 | $291.41 | $774.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $16,394.00
| Facility | | $627.00 | $1,818.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $127.70 / $127.70 / $127.70
| Facility | AS | $127.70 | $127.70 | $127.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.58 / $720.49 / $2,824.64
| Professional | | $431.58 | $720.49 | $2,824.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.66 / $570.10 / $1,008.99
| Professional | | $379.66 | $570.10 | $1,008.99 |