- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $829.84 / $1,055.81 / $6,272.00
| Facility | | $829.84 | $1,055.81 | $6,272.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.30 / $1,055.81 / $2,499.12
| Professional | | $786.30 | $1,055.81 | $2,499.12 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $61.79 / $257.12 / $640.75
| Professional | AS | $61.79 | $257.12 | $640.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,113.79 / $5,996.50 / $12,749.70
| Facility | | $2,113.79 | $5,996.50 | $12,749.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.33 / $2,175.44 / $3,708.44
| Professional | | $1,412.33 | $2,175.44 | $3,708.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,662.40 / $3,775.61 / $9,082.74
| Facility | | $2,662.40 | $3,775.61 | $9,082.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,715.53 / $2,777.00 / $4,555.04
| Professional | | $1,715.53 | $2,777.00 | $4,555.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,164.34 / $3,451.81 / $7,151.76
| Facility | | $2,164.34 | $3,451.81 | $7,151.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,502.24 / $2,524.57 / $4,281.38
| Professional | | $1,502.24 | $2,524.57 | $4,281.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $974.14 / $1,726.52 / $5,681.42
| Facility | | $974.14 | $1,726.52 | $5,681.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,298.93 / $2,136.98 / $6,420.24
| Professional | | $1,298.93 | $2,136.98 | $6,420.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,991.00 / $9,404.00 / $12,111.68
| Facility | | $3,991.00 | $9,404.00 | $12,111.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.09 / $1,912.27 / $4,174.64
| Professional | | $1,225.09 | $1,912.27 | $4,174.64 |