- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,663.12 / $3,693.00
| Facility | | $1,485.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $919.83 / $1,045.34 / $2,670.56
| Professional | | $919.83 | $1,045.34 | $2,670.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,366.42 / $5,737.16
| Facility | | $1,061.00 | $3,366.42 | $5,737.16 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $255.18 / $255.18 / $646.16
| Facility | AS | $255.18 | $255.18 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,049.84 / $1,727.34 / $7,241.20
| Professional | | $1,049.84 | $1,727.34 | $7,241.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,929.91 / $1,930.03 / $2,921.12
| Professional | | $1,929.91 | $1,930.03 | $2,921.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,094.08 / $1,787.43 / $2,897.12
| Professional | | $1,094.08 | $1,787.43 | $2,897.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $997.51 / $1,909.00 / $6,679.00
| Facility | | $997.51 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.64 / $1,386.54 / $1,888.48
| Professional | | $1,144.64 | $1,386.54 | $1,888.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.58 / $2,469.26 / $3,257.34
| Professional | | $1,245.58 | $2,469.26 | $3,257.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,764.00 / $9,039.00
| Facility | | $55.00 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $255.18 / $255.18 / $646.16
| Facility | AS | $255.18 | $255.18 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,105.13 / $1,815.36 / $7,241.20
| Professional | | $1,105.13 | $1,815.36 | $7,241.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.33 / $1,622.08 / $2,939.27
| Professional | | $1,102.33 | $1,622.08 | $2,939.27 |