- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $391.09 / $3,638.00 / $6,488.60
| Facility | | $391.09 | $3,638.00 | $6,488.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.68 / $549.11 / $1,311.30
| Professional | | $347.68 | $549.11 | $1,311.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,954.49 / $6,889.31 / $13,089.90
| Facility | | $3,954.49 | $6,889.31 | $13,089.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.04 / $1,312.81 / $2,016.56
| Professional | | $734.04 | $1,312.81 | $2,016.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,431.11 / $2,030.54 / $4,884.74
| Facility | | $1,431.11 | $2,030.54 | $4,884.74 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $66.11 / $66.11 / $66.11
| Facility | AS | $66.11 | $66.11 | $66.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.54 / $1,395.90 / $2,434.34
| Professional | | $831.54 | $1,395.90 | $2,434.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,301.01 / $1,856.40 / $3,846.25
| Facility | | $1,301.01 | $1,856.40 | $3,846.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.73 / $1,306.05 / $2,219.76
| Professional | | $802.73 | $1,306.05 | $2,219.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.09 / $803.84 / $1,831.00
| Facility | | $448.09 | $803.84 | $1,831.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $179.69 / $179.69 / $179.69
| Facility | AS | $179.69 | $179.69 | $179.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.74 / $1,116.00 / $2,928.16
| Professional | | $610.74 | $1,116.00 | $2,928.16 |
- 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
- $638.47 / $1,151.24 / $2,188.91
| Professional | | $638.47 | $1,151.24 | $2,188.91 |