- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.00 / $4,806.72 / $6,953.60
| Facility | | $478.00 | $4,806.72 | $6,953.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.12 / $452.84 / $1,181.96
| Professional | | $411.12 | $452.84 | $1,181.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.11 / $385.11 / $385.11
| Professional | | $385.11 | $385.11 | $385.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $517.84 / $776.77 / $1,227.13
| Professional | | $517.84 | $776.77 | $1,227.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.40 / $721.57 / $1,215.85
| Professional | | $510.40 | $721.57 | $1,215.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $432.49 / $557.67 / $961.42
| Facility | | $432.49 | $557.67 | $961.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.33 / $78.08 / $151.74
| Facility | AS | $70.33 | $78.08 | $151.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.67 / $557.67 / $1,130.63
| Professional | | $557.67 | $557.67 | $1,130.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $781.00 / $941.00
| Professional | | $4.00 | $781.00 | $941.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,526.00 / $7,659.00 / $10,502.00
| Facility | | $2,526.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.83 / $589.16 / $1,229.53
| Professional | | $420.83 | $589.16 | $1,229.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,073.94 / $6,817.20
| Facility | | $55.00 | $2,073.94 | $6,817.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $98.93 / $646.16 / $646.16
| Facility | AS | $98.93 | $646.16 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,165.12 / $3,835.13 / $3,835.13
| Professional | | $3,165.12 | $3,835.13 | $3,835.13 |