- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.11 / $491.43 / $4,661.31
| Facility | | $343.11 | $491.43 | $4,661.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.24 / $481.53 / $786.10
| Professional | | $316.24 | $481.53 | $786.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,677.15 / $6,097.04 / $11,496.64
| Facility | | $3,677.15 | $6,097.04 | $11,496.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.99 / $1,113.10 / $1,681.05
| Professional | | $635.99 | $1,113.10 | $1,681.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.82 / $1,685.35 / $4,054.33
| Facility | | $1,187.82 | $1,685.35 | $4,054.33 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $57.49 / $57.49 / $57.49
| Facility | AS | $57.49 | $57.49 | $57.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.15 / $1,188.45 / $2,002.72
| Professional | | $709.15 | $1,188.45 | $2,002.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.83 / $1,540.81 / $3,192.39
| Facility | | $1,079.83 | $1,540.81 | $3,192.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $685.70 / $1,080.47 / $1,826.18
| Professional | | $685.70 | $1,080.47 | $1,826.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.27 / $763.34 / $1,843.00
| Facility | | $437.27 | $763.34 | $1,843.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.86 / $154.86 / $154.86
| Facility | AS | $154.86 | $154.86 | $154.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.72 / $1,024.98 / $2,553.36
| Professional | | $566.72 | $1,024.98 | $2,553.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $6,900.83 / $9,468.59
| Facility | | $2,412.00 | $6,900.83 | $9,468.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.55 / $978.88 / $1,895.17
| Professional | | $531.55 | $978.88 | $1,895.17 |