- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.59 / $2,299.00 / $4,424.00
| Facility | | $458.59 | $2,299.00 | $4,424.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $493.87 / $1,929.00
| Professional | | $426.58 | $493.87 | $1,929.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,098.09 / $4,128.39 / $6,533.93
| Facility | | $2,098.09 | $4,128.39 | $6,533.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $828.77 / $1,327.88 / $1,732.69
| Professional | | $828.77 | $1,327.88 | $1,732.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,113.74 / $1,580.24 / $3,801.48
| Facility | | $1,113.74 | $1,580.24 | $3,801.48 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $53.09 / $53.09 / $53.09
| Facility | AS | $53.09 | $53.09 | $53.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.43 / $1,332.41 / $1,978.84
| Professional | | $836.43 | $1,332.41 | $1,978.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.49 / $1,444.72 / $2,993.29
| Facility | | $1,012.49 | $1,444.72 | $2,993.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $757.28 / $1,191.27 / $1,814.71
| Professional | | $757.28 | $1,191.27 | $1,814.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $497.28 / $943.89 / $4,900.35
| Facility | | $497.28 | $943.89 | $4,900.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.78 / $118.78 / $118.78
| Facility | AS | $118.78 | $118.78 | $118.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $506.29 / $909.35 / $1,842.46
| Professional | | $506.29 | $909.35 | $1,842.46 |
- 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
- $506.29 / $904.40 / $1,794.12
| Professional | | $506.29 | $904.40 | $1,794.12 |