- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $361.25 / $7,119.04 / $19,482.36
| Facility | | $361.25 | $7,119.04 | $19,482.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.00 / $360.24 / $898.46
| Professional | | $110.00 | $360.24 | $898.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,335.87 / $4,387.57 / $8,486.99
| Facility | | $3,335.87 | $4,387.57 | $8,486.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.15 / $355.77 / $721.89
| Professional | | $173.15 | $355.77 | $721.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,239.12 / $7,239.12 / $7,239.12
| Facility | | $7,239.12 | $7,239.12 | $7,239.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.26 / $740.79 / $1,095.60
| Professional | | $343.26 | $740.79 | $1,095.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.45 / $555.61 / $2,851.49
| Facility | | $194.45 | $555.61 | $2,851.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $82.05 / $82.05 / $82.05
| Facility | AS | $82.05 | $82.05 | $82.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.10 / $838.08 / $1,473.06
| Professional | | $494.10 | $838.08 | $1,473.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.25 / $931.44 / $8,686.94
| Facility | | $425.25 | $931.44 | $8,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.47 / $785.58 / $1,059.58
| Professional | | $394.47 | $785.58 | $1,059.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $6,178.00 / $8,632.00
| Facility | | $4,700.00 | $6,178.00 | $8,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.88 / $817.17 / $1,064.22
| Professional | | $468.88 | $817.17 | $1,064.22 |