- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,467.37 / $5,623.41
| Facility | | $2,041.74 | $3,467.37 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,230.27 / $3,467.37
| Professional | | $676.08 | $1,230.27 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,630.27 / $7,762.47
| Facility | | $56.23 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | AS | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,122.02 / $3,019.95
| Professional | | $660.69 | $1,122.02 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,479.11 / $1,949.84
| Professional | | $870.96 | $1,479.11 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,122.02 / $2,041.74
| Professional | | $724.44 | $1,122.02 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.95 / $1,513.56 / $7,079.46
| Facility | | $707.95 | $1,513.56 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $977.24 / $1,348.96
| Professional | | $776.25 | $977.24 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $4,265.80 / $9,772.37
| Facility | | $1,995.26 | $4,265.80 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,348.96 / $2,137.96
| Professional | | $724.44 | $1,348.96 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $5,370.32 / $8,511.38
| Facility | | $1,348.96 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,513.56
| Professional | | $1,348.96 | $1,348.96 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,630.27 / $7,762.47
| Facility | | $56.23 | $2,630.27 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | AS | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,122.02 / $3,019.95
| Professional | | $660.69 | $1,122.02 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.09 / $4,265.80 / $9,549.93
| Facility | | $1,862.09 | $4,265.80 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,148.15 / $2,187.76
| Professional | | $776.25 | $1,148.15 | $2,187.76 |