- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.79 / $2,772.00 / $16,176.18
| Facility | | $419.79 | $2,772.00 | $16,176.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.68 / $419.79 / $680.26
| Professional | | $377.68 | $419.79 | $680.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,503.12 / $3,011.30 / $5,761.70
| Facility | | $1,503.12 | $3,011.30 | $5,761.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $751.36 / $1,203.85 / $1,570.86
| Professional | | $751.36 | $1,203.85 | $1,570.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.67 / $1,452.43 / $3,494.02
| Facility | | $1,023.67 | $1,452.43 | $3,494.02 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $48.13 / $48.13 / $48.13
| Facility | AS | $48.13 | $48.13 | $48.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.24 / $1,223.79 / $1,817.51
| Professional | | $768.24 | $1,223.79 | $1,817.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $930.60 / $1,327.87 / $2,751.20
| Facility | | $930.60 | $1,327.87 | $2,751.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.54 / $1,094.15 / $1,666.76
| Professional | | $695.54 | $1,094.15 | $1,666.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.83 / $853.81 / $3,906.64
| Facility | | $436.83 | $853.81 | $3,906.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.73 / $108.73 / $108.73
| Facility | AS | $108.73 | $108.73 | $108.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.36 / $826.43 / $1,672.91
| Professional | | $455.36 | $826.43 | $1,672.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $453.63 / $786.38 / $1,657.15
| Professional | | $453.63 | $786.38 | $1,657.15 |