- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.89 / $6,732.07 / $16,762.57
| Facility | | $493.89 | $6,732.07 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.49 / $493.89 / $1,264.50
| Professional | | $317.49 | $493.89 | $1,264.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.67 / $691.27 / $1,013.36
| Professional | | $376.67 | $691.27 | $1,013.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,257.44 / $1,257.44 / $1,257.44
| Facility | | $1,257.44 | $1,257.44 | $1,257.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.71 / $1,039.89 / $1,547.20
| Professional | | $497.71 | $1,039.89 | $1,547.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.66 / $704.38 / $1,992.24
| Facility | | $421.66 | $704.38 | $1,992.24 |
- 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
- $653.60 / $1,080.96 / $2,862.72
| Professional | | $653.60 | $1,080.96 | $2,862.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $805.75 / $1,175.40 / $1,597.11
| Facility | | $805.75 | $1,175.40 | $1,597.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $723.94 / $998.28 / $1,424.38
| Professional | | $723.94 | $998.28 | $1,424.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.60 / $1,080.96 / $1,407.76
| Professional | | $653.60 | $1,080.96 | $1,407.76 |