- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $2,344.23 / $8,511.38
| Facility | | $954.99 | $2,344.23 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $724.44 / $1,905.46
| Professional | | $275.42 | $724.44 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $1,071.52
| Professional | | $144.54 | $144.54 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,890.45 / $7,585.78
| Facility | | $3,019.95 | $3,890.45 | $7,585.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $794.33 / $1,122.02
| Professional | | $478.63 | $794.33 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,148.15 / $1,513.56
| Professional | | $512.86 | $1,148.15 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $812.83 / $5,248.07
| Facility | | $457.09 | $812.83 | $5,248.07 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $131.83 / $501.19 / $501.19
| Facility | AS | $131.83 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $851.14 / $5,370.32
| Professional | | $457.09 | $851.14 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,148.15 / $1,548.82
| Professional | | $1,000.00 | $1,148.15 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Facility | | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,174.90 / $1,548.82
| Professional | | $1,122.02 | $1,174.90 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $812.83 / $1,071.52
| Professional | | $457.09 | $812.83 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $4,365.16 / $8,128.31
| Facility | | $2,398.83 | $4,365.16 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $1,230.27
| Professional | | $524.81 | $891.25 | $1,230.27 |