- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $399.18 / $2,571.29 / $7,099.92
| Facility | | $399.18 | $2,571.29 | $7,099.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.87 / $419.77 / $1,621.00
| Professional | | $369.87 | $419.77 | $1,621.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,419.54 / $5,213.67 / $10,098.06
| Facility | | $2,419.54 | $5,213.67 | $10,098.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.02 / $1,145.51 / $1,499.07
| Professional | | $717.02 | $1,145.51 | $1,499.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $972.31 / $1,379.57 / $3,318.75
| Facility | | $972.31 | $1,379.57 | $3,318.75 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $45.93 / $45.93 / $45.93
| Facility | AS | $45.93 | $45.93 | $45.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $730.08 / $1,163.00 / $1,727.23
| Professional | | $730.08 | $1,163.00 | $1,727.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.92 / $1,261.26 / $2,613.19
| Facility | | $883.92 | $1,261.26 | $2,613.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.99 / $1,039.80 / $1,583.97
| Professional | | $660.99 | $1,039.80 | $1,583.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.99 / $811.11 / $4,974.00
| Facility | | $414.99 | $811.11 | $4,974.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.38 / $103.38 / $103.38
| Facility | AS | $103.38 | $103.38 | $103.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.03 / $788.82 / $1,601.88
| Professional | | $436.03 | $788.82 | $1,601.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.00 / $3,584.00 / $8,193.00
| Facility | | $1,356.00 | $3,584.00 | $8,193.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.50 / $783.64 / $1,586.79
| Professional | | $444.50 | $783.64 | $1,586.79 |