- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $418.10 / $3,809.16 / $11,468.82
| Facility | | $418.10 | $3,809.16 | $11,468.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.08 / $603.54 / $1,920.42
| Professional | | $389.08 | $603.54 | $1,920.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,580.01 / $5,792.97 / $10,098.06
| Facility | | $3,580.01 | $5,792.97 | $10,098.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $791.55 / $1,385.87 / $2,124.48
| Professional | | $791.55 | $1,385.87 | $2,124.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.83 / $2,108.17 / $5,071.51
| Facility | | $1,485.83 | $2,108.17 | $5,071.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $71.40 / $71.40 / $71.40
| Facility | AS | $71.40 | $71.40 | $71.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.69 / $1,449.65 / $2,529.30
| Professional | | $881.69 | $1,449.65 | $2,529.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.75 / $1,927.38 / $3,993.31
| Facility | | $1,350.75 | $1,927.38 | $3,993.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.25 / $1,357.00 / $2,306.34
| Professional | | $849.25 | $1,357.00 | $2,306.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.82 / $1,037.78 / $4,774.88
| Facility | | $409.82 | $1,037.78 | $4,774.88 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $193.77 / $193.77 / $193.77
| Facility | AS | $193.77 | $193.77 | $193.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.40 / $1,252.77 / $2,476.67
| Professional | | $653.40 | $1,252.77 | $2,476.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,412.00 / $4,746.00 / $8,812.00
| Facility | | $2,412.00 | $4,746.00 | $8,812.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.31 / $1,174.42 / $2,313.44
| Professional | | $676.31 | $1,174.42 | $2,313.44 |