- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $478.63 / $5,370.32
| Facility | | $331.13 | $478.63 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $758.58
| Professional | | $309.03 | $446.68 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,235.94 / $7,413.10
| Facility | | $2,041.74 | $3,235.94 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $1,621.81
| Professional | | $575.44 | $912.01 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,737.80 / $4,168.69
| Facility | | $1,230.27 | $1,737.80 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $57.54 / $57.54 / $57.54
| Facility | AS | $57.54 | $57.54 | $57.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,288.25 / $2,041.74
| Professional | | $724.44 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,659.59 / $3,235.94
| Facility | | $1,348.96 | $1,659.59 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,096.48 / $1,862.09
| Professional | | $724.44 | $1,096.48 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $812.83 / $4,168.69
| Facility | | $457.09 | $812.83 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,000.00 / $2,630.27
| Professional | | $537.03 | $1,000.00 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $4,168.69 / $6,760.83
| Facility | | $1,584.89 | $4,168.69 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $812.83 / $1,698.24
| Professional | | $467.74 | $812.83 | $1,698.24 |