- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $796.64 / $6,345.10 / $13,841.56
| Facility | | $796.64 | $6,345.10 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.26 / $554.38 / $2,047.41
| Professional | | $366.26 | $554.38 | $2,047.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.49 / $720.48 / $914.33
| Professional | | $356.49 | $720.48 | $914.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,303.68 / $6,975.78 / $13,493.42
| Facility | | $5,303.68 | $6,975.78 | $13,493.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.62 / $751.09 / $1,126.50
| Professional | | $407.62 | $751.09 | $1,126.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.85 / $1,802.85 / $1,802.85
| Facility | | $1,802.85 | $1,802.85 | $1,802.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.27 / $1,170.57 / $1,712.07
| Professional | | $583.27 | $1,170.57 | $1,712.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.00 / $942.45 / $4,767.99
| Facility | | $405.00 | $942.45 | $4,767.99 |
- 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
- $688.57 / $1,118.93 / $3,121.12
| Professional | | $688.57 | $1,118.93 | $3,121.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $931.59 / $1,311.48 / $2,163.42
| Facility | | $931.59 | $1,311.48 | $2,163.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.05 / $1,174.89 / $1,615.90
| Professional | | $808.05 | $1,174.89 | $1,615.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.04 / $765.51 / $1,192.68
| Professional | | $439.04 | $765.51 | $1,192.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.95 / $1,262.61 / $1,606.67
| Professional | | $745.95 | $1,262.61 | $1,606.67 |