- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,467.37 / $6,606.93
| Facility | | $1,023.29 | $3,467.37 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $2,041.74 / $7,943.28
| Professional | | $1,202.26 | $2,041.74 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,412.54
| Professional | | $1,348.96 | $1,348.96 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $2,041.74 / $3,090.30
| Facility | | $630.96 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,258.93 / $2,454.71
| Professional | | $1,000.00 | $1,258.93 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,445.44 / $2,398.83
| Professional | | $1,202.26 | $1,445.44 | $2,398.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,862.09 / $6,918.31
| Facility | | $1,348.96 | $1,862.09 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,344.23 / $2,344.23 / $6,606.93
| Facility | 62 | $2,344.23 | $2,344.23 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $380.19 / $380.19 / $1,047.13
| Facility | AS | $380.19 | $380.19 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,584.89 / $12,022.64
| Professional | | $1,318.26 | $1,584.89 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $4,073.80 / $7,244.36
| Facility | | $3,090.30 | $4,073.80 | $7,244.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,412.54 / $1,949.84
| Professional | | $1,174.90 | $1,412.54 | $1,949.84 |