- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $171.23 / $3,588.88 / $12,036.14
| Facility | | $171.23 | $3,588.88 | $12,036.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.23 / $416.63 / $994.11
| Professional | | $171.23 | $416.63 | $994.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.86 / $317.57 / $473.85
| Professional | | $180.86 | $317.57 | $473.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,309.18 / $4,352.47 / $8,419.09
| Facility | | $3,309.18 | $4,352.47 | $8,419.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.05 / $306.89 / $411.87
| Professional | | $180.05 | $306.89 | $411.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.07 / $490.08 / $634.03
| Professional | | $270.07 | $490.08 | $634.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.32 / $610.02 / $3,726.00
| Facility | | $218.32 | $610.02 | $3,726.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.53 / $85.53 / $85.53
| Facility | AS | $85.53 | $85.53 | $85.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.17 / $502.33 / $2,196.12
| Professional | | $270.17 | $502.33 | $2,196.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.74 / $535.60 / $1,203.26
| Facility | | $405.74 | $535.60 | $1,203.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.93 / $482.54 / $600.04
| Professional | | $356.93 | $482.54 | $600.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.52 / $337.42 / $437.56
| Professional | | $193.52 | $337.42 | $437.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $3,726.00 / $7,934.00
| Facility | | $3,044.00 | $3,726.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.17 / $484.43 / $612.25
| Professional | | $270.17 | $484.43 | $612.25 |