- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.92 / $3,999.83 / $6,955.00
| Facility | | $437.92 | $3,999.83 | $6,955.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.05 / $460.99 / $1,820.00
| Professional | | $406.05 | $460.99 | $1,820.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,393.22 / $5,677.11 / $10,098.06
| Facility | | $3,393.22 | $5,677.11 | $10,098.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.19 / $1,260.81 / $1,649.94
| Professional | | $789.19 | $1,260.81 | $1,649.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.07 / $1,509.77 / $3,631.95
| Facility | | $1,064.07 | $1,509.77 | $3,631.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $50.56 / $50.56 / $50.56
| Facility | AS | $50.56 | $50.56 | $50.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.64 / $1,270.63 / $1,887.07
| Professional | | $797.64 | $1,270.63 | $1,887.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.34 / $1,380.29 / $2,859.80
| Facility | | $967.34 | $1,380.29 | $2,859.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $722.16 / $1,136.03 / $1,730.56
| Professional | | $722.16 | $1,136.03 | $1,730.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $474.34 / $895.68 / $5,302.88
| Facility | | $474.34 | $895.68 | $5,302.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $113.23 / $113.23 / $113.23
| Facility | AS | $113.23 | $113.23 | $113.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.15 / $860.60 / $1,744.98
| Professional | | $479.15 | $860.60 | $1,744.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.71 / $844.84 / $1,744.98
| Professional | | $511.71 | $844.84 | $1,744.98 |