- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.61 / $603.72 / $7,099.92
| Facility | | $442.61 | $603.72 | $7,099.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $442.61 / $603.72 / $991.41
| Professional | | $442.61 | $603.72 | $991.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,027.80 / $5,844.30 / $11,503.06
| Facility | | $2,027.80 | $5,844.30 | $11,503.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.27 / $1,401.40 / $2,088.12
| Professional | | $829.27 | $1,401.40 | $2,088.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,477.41 / $2,096.23 / $5,042.77
| Facility | | $1,477.41 | $2,096.23 | $5,042.77 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.09 / $75.09 / $75.09
| Facility | AS | $75.09 | $75.09 | $75.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.44 / $1,503.82 / $2,523.55
| Professional | | $939.44 | $1,503.82 | $2,523.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.10 / $1,916.46 / $3,970.69
| Facility | | $1,343.10 | $1,916.46 | $3,970.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $864.02 / $1,367.11 / $2,301.09
| Professional | | $864.02 | $1,367.11 | $2,301.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.65 / $909.71 / $2,083.84
| Facility | | $533.65 | $909.71 | $2,083.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $203.00 / $203.00 / $203.00
| Facility | AS | $203.00 | $203.00 | $203.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $671.50 / $1,223.16 / $3,320.96
| Professional | | $671.50 | $1,223.16 | $3,320.96 |
- 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
- $671.50 / $1,145.08 / $2,322.69
| Professional | | $671.50 | $1,145.08 | $2,322.69 |