- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.69 / $2,663.12 / $3,625.00
| Facility | | $535.69 | $2,663.12 | $3,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.72 / $519.86 / $880.02
| Professional | | $339.72 | $519.86 | $880.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.02 / $2,854.00 / $9,039.00
| Facility | | $845.02 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $178.46 / $178.46 / $178.46
| Facility | AS | $178.46 | $178.46 | $178.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.07 / $886.38 / $3,888.48
| Professional | | $409.07 | $886.38 | $3,888.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.19 / $536.09 / $957.03
| Facility | | $417.19 | $536.09 | $957.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $855.97 / $1,361.36
| Professional | | $584.90 | $855.97 | $1,361.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.73 / $763.07 / $1,470.76
| Professional | | $450.73 | $763.07 | $1,470.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $352.07 / $760.70 / $6,679.00
| Facility | | $352.07 | $760.70 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.37 / $727.34 / $1,004.01
| Professional | | $597.37 | $727.34 | $1,004.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.75 / $960.04 / $1,503.63
| Professional | | $456.75 | $960.04 | $1,503.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,784.74 / $4,784.74 / $4,784.74
| Facility | | $4,784.74 | $4,784.74 | $4,784.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.86 / $547.86 / $547.86
| Professional | | $547.86 | $547.86 | $547.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,784.58 / $3,764.00 / $16,394.00
| Facility | | $1,784.58 | $3,764.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $178.46 / $178.46 / $178.46
| Facility | AS | $178.46 | $178.46 | $178.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.48 / $1,126.03 / $3,888.48
| Professional | | $609.48 | $1,126.03 | $3,888.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $8,766.00
| Facility | | $1,902.00 | $3,764.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.25 / $880.39 / $2,216.27
| Professional | | $593.25 | $880.39 | $2,216.27 |