- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,012.00 / $2,747.00 / $7,304.00
| Facility | | $1,012.00 | $2,747.00 | $7,304.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $476.26 / $704.02 / $1,642.23
| Professional | | $476.26 | $704.02 | $1,642.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.94 / $2,854.00 / $9,039.00
| Facility | | $1,035.94 | $2,854.00 | $9,039.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $236.65 / $236.65 / $236.65
| Facility | AS | $236.65 | $236.65 | $236.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.11 / $1,156.77 / $4,857.55
| Professional | | $528.11 | $1,156.77 | $4,857.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.01 / $710.62 / $1,268.59
| Facility | | $553.01 | $710.62 | $1,268.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $795.78 / $1,148.44 / $1,839.87
| Professional | | $795.78 | $1,148.44 | $1,839.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $584.90 / $998.50 / $1,877.94
| Professional | | $584.90 | $998.50 | $1,877.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.83 / $1,008.36 / $6,679.00
| Facility | | $467.83 | $1,008.36 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $792.03 / $962.71 / $1,328.92
| Professional | | $792.03 | $962.71 | $1,328.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $607.28 / $1,272.42 / $1,974.28
| Professional | | $607.28 | $1,272.42 | $1,974.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,704.96 / $2,867.80 / $7,800.59
| Facility | | $1,704.96 | $2,867.80 | $7,800.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.32 / $925.40 / $1,439.73
| Professional | | $636.32 | $925.40 | $1,439.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,764.00 / $26,542.00
| Facility | | $1,902.00 | $3,764.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $236.65 / $236.65 / $236.65
| Facility | AS | $236.65 | $236.65 | $236.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $780.23 / $1,510.14 / $4,962.56
| Professional | | $780.23 | $1,510.14 | $4,962.56 |
- 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
- $736.03 / $1,121.36 / $2,380.01
| Professional | | $736.03 | $1,121.36 | $2,380.01 |