- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.84 / $5,233.88 / $7,993.00
| Facility | | $594.84 | $5,233.88 | $7,993.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.88 / $439.84 / $997.79
| Professional | | $389.88 | $439.84 | $997.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,794.89 / $1,794.89 / $1,821.08
| Facility | | $1,794.89 | $1,794.89 | $1,821.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.21 / $670.60 / $1,198.21
| Professional | | $427.21 | $670.60 | $1,198.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $1,215.60
| Facility | | $606.10 | $606.10 | $1,215.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.92 / $613.78 / $1,063.98
| Professional | | $462.92 | $613.78 | $1,063.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.31 / $528.96 / $774.49
| Facility | | $412.31 | $528.96 | $774.49 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $74.05 / $74.05 / $136.22
| Facility | AS | $74.05 | $74.05 | $136.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.00 / $522.00 / $544.00
| Professional | | $522.00 | $522.00 | $544.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $553.70 / $1,114.00
| Professional | | $3.00 | $553.70 | $1,114.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.26 / $556.36 / $1,128.48
| Professional | | $379.26 | $556.36 | $1,128.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,506.49 / $4,017.35
| Facility | | $55.00 | $3,506.49 | $4,017.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $95.18 / $228.94 / $380.79
| Facility | AS | $95.18 | $228.94 | $380.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,037.36 / $3,661.43 / $3,661.43
| Professional | | $3,037.36 | $3,661.43 | $3,661.43 |