- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.41 / $1,919.00 / $4,298.43
| Facility | | $736.41 | $1,919.00 | $4,298.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.56 / $695.81 / $1,717.23
| Professional | | $447.56 | $695.81 | $1,717.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,630.26 / $9,039.00
| Facility | | $1,061.00 | $3,630.26 | $9,039.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.63 / $132.63 / $497.27
| Facility | AS | $132.63 | $132.63 | $497.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.21 / $859.80 / $5,389.20
| Professional | | $489.21 | $859.80 | $5,389.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $783.25 / $1,026.08 / $1,363.62
| Professional | | $783.25 | $1,026.08 | $1,363.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $552.03 / $837.40 / $1,387.16
| Professional | | $552.03 | $837.40 | $1,387.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $515.36 / $1,119.24 / $6,679.00
| Facility | | $515.36 | $1,119.24 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.38 / $716.35 / $984.93
| Professional | | $591.38 | $716.35 | $984.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.29 / $1,259.40 / $2,008.56
| Professional | | $635.29 | $1,259.40 | $2,008.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.41 / $0.41 / $3,050.05
| Facility | | $0.41 | $0.41 | $3,050.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,897.68 / $3,997.00 / $16,394.00
| Facility | | $1,897.68 | $3,997.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.63 / $132.63 / $497.27
| Facility | AS | $132.63 | $132.63 | $497.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.66 / $945.33 / $5,389.20
| Professional | | $523.66 | $945.33 | $5,389.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,902.00 / $3,997.00 / $8,766.00
| Facility | | $1,902.00 | $3,997.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.66 / $783.47 / $1,518.98
| Professional | | $523.66 | $783.47 | $1,518.98 |