- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.68 / $1,778.28 / $8,128.31
| Facility | | $446.68 | $1,778.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $602.56 / $1,445.44
| Professional | | $426.58 | $602.56 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $6,456.54 / $14,791.08
| Facility | | $2,630.27 | $6,456.54 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,202.26 / $2,041.74
| Professional | | $758.58 | $1,202.26 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $2,187.76 / $5,248.07
| Facility | | $1,548.82 | $2,187.76 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $75.86 / $75.86 / $75.86
| Facility | AS | $75.86 | $75.86 | $75.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,548.82 / $2,511.89
| Professional | | $933.25 | $1,548.82 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,089.30 / $4,168.69
| Facility | | $1,698.24 | $2,089.30 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,479.11 / $2,398.83
| Professional | | $912.01 | $1,479.11 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $933.25 / $4,265.80
| Facility | | $489.78 | $933.25 | $4,265.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,230.27 / $3,311.31
| Professional | | $602.56 | $1,230.27 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,786.30 / $8,912.51
| Facility | | $2,398.83 | $4,786.30 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $933.25 / $1,819.70
| Professional | | $512.86 | $933.25 | $1,819.70 |