- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $463.88 / $2,838.15 / $13,335.00
| Facility | | $463.88 | $2,838.15 | $13,335.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.47 / $463.87 / $811.79
| Professional | | $358.47 | $463.87 | $811.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.31 / $339.31 / $339.31
| Professional | | $339.31 | $339.31 | $339.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,354.75 / $5,350.19 / $9,195.94
| Facility | | $2,354.75 | $5,350.19 | $9,195.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.00 / $379.12 / $581.97
| Professional | | $290.00 | $379.12 | $581.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $462.38 / $1,965.14 / $2,345.00
| Facility | | $462.38 | $1,965.14 | $2,345.00 |
- 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
- $460.34 / $560.16 / $896.45
| Professional | | $460.34 | $560.16 | $896.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.97 / $510.27 / $892.22
| Facility | | $417.97 | $510.27 | $892.22 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $70.31 / $70.31 / $118.55
| Facility | AS | $70.31 | $70.31 | $118.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,606.69 / $1,606.69 / $1,606.69
| Professional | | $1,606.69 | $1,606.69 | $1,606.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.90 / $342.42 / $578.23
| Professional | | $69.90 | $342.42 | $578.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,981.00 / $10,147.00 / $16,816.00
| Facility | | $1,981.00 | $10,147.00 | $16,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.66 / $473.64 / $985.23
| Professional | | $338.66 | $473.64 | $985.23 |