- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.60 / $2,083.00 / $4,088.00
| Facility | | $736.60 | $2,083.00 | $4,088.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.61 / $628.04 / $1,617.70
| Professional | | $469.61 | $628.04 | $1,617.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.47 / $1,878.00 / $5,737.16
| Facility | | $588.47 | $1,878.00 | $5,737.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.86 / $133.86 / $646.16
| Facility | AS | $133.86 | $133.86 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.61 / $875.22 / $3,783.52
| Professional | | $538.61 | $875.22 | $3,783.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,018.68 / $1,018.74 / $1,541.87
| Professional | | $1,018.68 | $1,018.74 | $1,541.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.45 / $896.11 / $1,497.56
| Professional | | $562.45 | $896.11 | $1,497.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.71 / $1,132.72 / $6,679.00
| Facility | | $523.71 | $1,132.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.96 / $727.96 / $996.79
| Professional | | $600.96 | $727.96 | $996.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.85 / $1,284.78 / $1,687.92
| Professional | | $650.85 | $1,284.78 | $1,687.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.53 / $3,025.53 / $6,079.20
| Facility | | $3,025.53 | $3,025.53 | $6,079.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.11 / $876.10 / $1,068.00
| Professional | | $454.11 | $876.10 | $1,068.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,078.00 / $7,161.00
| Facility | | $55.00 | $2,078.00 | $7,161.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.86 / $133.86 / $646.16
| Facility | AS | $133.86 | $133.86 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.42 / $930.97 / $3,783.52
| Professional | | $571.42 | $930.97 | $3,783.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,106.00 / $2,408.00 / $5,683.00
| Facility | | $1,106.00 | $2,408.00 | $5,683.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.14 / $843.82 / $1,693.19
| Professional | | $561.14 | $843.82 | $1,693.19 |