- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.31 / $496.31 / $6,727.43
| Facility | | $496.31 | $496.31 | $6,727.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.56 / $501.08 / $845.36
| Professional | | $447.56 | $501.08 | $845.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,165.29 / $3,857.56 / $7,573.89
| Facility | | $2,165.29 | $3,857.56 | $7,573.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.14 / $1,438.40 / $1,882.35
| Professional | | $891.14 | $1,438.40 | $1,882.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.54 / $1,785.68 / $4,295.70
| Facility | | $1,258.54 | $1,785.68 | $4,295.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $57.68 / $57.68 / $57.68
| Facility | AS | $57.68 | $57.68 | $57.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $943.41 / $1,502.83 / $2,231.92
| Professional | | $943.41 | $1,502.83 | $2,231.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.11 / $1,632.54 / $3,382.44
| Facility | | $1,144.11 | $1,632.54 | $3,382.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.13 / $1,343.63 / $2,046.81
| Professional | | $854.13 | $1,343.63 | $2,046.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.65 / $975.04 / $5,058.83
| Facility | | $560.65 | $975.04 | $5,058.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.63 / $132.63 / $132.63
| Facility | AS | $132.63 | $132.63 | $132.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.37 / $988.12 / $2,209.09
| Professional | | $539.37 | $988.12 | $2,209.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $5,058.83 / $8,812.00
| Facility | | $2,412.00 | $5,058.83 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.97 / $975.02 / $2,005.82
| Professional | | $537.97 | $975.02 | $2,005.82 |