- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.64 / $548.53 / $4,828.00
| Facility | | $385.64 | $548.53 | $4,828.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.93 / $502.31 / $829.69
| Professional | | $336.93 | $502.31 | $829.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,088.76 / $4,512.21 / $9,603.34
| Facility | | $2,088.76 | $4,512.21 | $9,603.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.53 / $1,238.97 / $1,881.65
| Professional | | $723.53 | $1,238.97 | $1,881.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,342.72 / $1,905.12 / $4,583.03
| Facility | | $1,342.72 | $1,905.12 | $4,583.03 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $64.73 / $64.73 / $64.73
| Facility | AS | $64.73 | $64.73 | $64.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $817.66 / $1,332.06 / $2,309.17
| Professional | | $817.66 | $1,332.06 | $2,309.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,220.65 / $1,741.74 / $3,608.69
| Facility | | $1,220.65 | $1,741.74 | $3,608.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.62 / $1,245.80 / $2,105.62
| Professional | | $790.62 | $1,245.80 | $2,105.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.11 / $798.85 / $2,135.73
| Facility | | $413.11 | $798.85 | $2,135.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $177.12 / $177.12 / $177.12
| Facility | AS | $177.12 | $177.12 | $177.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.26 / $1,076.05 / $2,862.72
| Professional | | $593.26 | $1,076.05 | $2,862.72 |
- 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
- $575.23 / $1,024.73 / $1,999.62
| Professional | | $575.23 | $1,024.73 | $1,999.62 |