- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $363.08 / $1,412.54 / $6,918.31
| Facility | | $363.08 | $1,412.54 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.88 / $512.86 / $2,344.23
| Professional | | $239.88 | $512.86 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $31.62 / $85.11 / $575.44
| Professional | AS | $31.62 | $85.11 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $3,548.13 / $4,365.16
| Facility | | $1,584.89 | $3,548.13 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $467.74 / $489.78
| Professional | | $407.38 | $467.74 | $489.78 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $54.95 / $63.10 / $66.07
| Professional | AS | $54.95 | $63.10 | $66.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $354.81 / $436.52
| Professional | | $275.42 | $354.81 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.15 / $602.56 / $9,120.11
| Facility | | $269.15 | $602.56 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $575.44
| Professional | | $323.59 | $426.58 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $30.90 / $67.61 / $213.80
| Professional | AS | $30.90 | $67.61 | $213.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $32.36 / $33.11
| Professional | | $32.36 | $32.36 | $33.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $489.78 / $537.03
| Professional | | $354.81 | $489.78 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $218.78 / $630.96
| Professional | | $199.53 | $218.78 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $1,819.70 / $9,332.54
| Facility | | $151.36 | $1,819.70 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $380.19 / $537.03
| Professional | | $275.42 | $380.19 | $537.03 |