- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.41 / $2,634.00 / $4,557.00
| Facility | | $412.41 | $2,634.00 | $4,557.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.80 / $431.33 / $1,090.15
| Professional | | $380.80 | $431.33 | $1,090.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,810.92 / $5,213.67 / $10,098.06
| Facility | | $1,810.92 | $5,213.67 | $10,098.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.47 / $1,188.01 / $1,550.17
| Professional | | $741.47 | $1,188.01 | $1,550.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.62 / $1,422.57 / $3,422.19
| Facility | | $1,002.62 | $1,422.57 | $3,422.19 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $47.50 / $47.50 / $47.50
| Facility | AS | $47.50 | $47.50 | $47.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $753.85 / $1,200.86 / $1,783.47
| Professional | | $753.85 | $1,200.86 | $1,783.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.47 / $1,300.57 / $2,694.64
| Facility | | $911.47 | $1,300.57 | $2,694.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $682.51 / $1,073.66 / $1,635.55
| Professional | | $682.51 | $1,073.66 | $1,635.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.78 / $838.07 / $4,746.00
| Facility | | $428.78 | $838.07 | $4,746.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $106.84 / $106.84 / $106.84
| Facility | AS | $106.84 | $106.84 | $106.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.16 / $812.97 / $1,653.80
| Professional | | $450.16 | $812.97 | $1,653.80 |
- 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
- $450.16 / $792.68 / $1,595.23
| Professional | | $450.16 | $792.68 | $1,595.23 |