- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $2,691.53 / $9,549.93
| Facility | | $524.81 | $2,691.53 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $660.69 / $2,511.89
| Professional | | $478.63 | $660.69 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $6,760.83 / $13,182.57
| Facility | | $3,090.30 | $6,760.83 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $1,905.46
| Professional | | $831.76 | $1,258.93 | $1,905.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $4,466.84
| Facility | | $1,348.96 | $1,905.46 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $89.13 / $89.13 / $89.13
| Facility | AS | $89.13 | $89.13 | $89.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,548.82 / $2,290.87
| Professional | | $912.01 | $1,548.82 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,819.70 / $3,548.13
| Facility | | $1,445.44 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,288.25 / $2,041.74
| Professional | | $977.24 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $1,047.13 / $3,981.07
| Facility | | $524.81 | $1,047.13 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $977.24 / $2,884.03
| Professional | | $512.86 | $977.24 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,884.03 / $6,760.83
| Facility | | $1,174.90 | $2,884.03 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $912.01 / $1,862.09
| Professional | | $524.81 | $912.01 | $1,862.09 |