- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,506.15 / $3,908.01 / $13,841.56
| Facility | | $1,506.15 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.65 / $826.99 / $2,498.00
| Professional | | $477.65 | $826.99 | $2,498.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,609.82 / $6,063.17 / $11,728.12
| Facility | | $4,609.82 | $6,063.17 | $11,728.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.75 / $785.37 / $1,047.16
| Professional | | $460.75 | $785.37 | $1,047.16 |
- 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
- $725.00 / $1,155.88 / $1,549.62
| Professional | | $725.00 | $1,155.88 | $1,549.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $477.65 / $835.89 / $4,236.79
| Facility | | $477.65 | $835.89 | $4,236.79 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $133.86 / $646.16 / $646.16
| Facility | AS | $133.86 | $646.16 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.89 / $1,045.05 / $1,433.38
| Professional | | $631.89 | $1,045.05 | $1,433.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.79 / $1,281.80 / $2,256.42
| Facility | | $786.79 | $1,281.80 | $2,256.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.79 / $1,143.03 / $1,549.62
| Professional | | $786.79 | $1,143.03 | $1,549.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $631.89 / $1,079.08 / $1,361.00
| Professional | | $631.89 | $1,079.08 | $1,361.00 |