- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,653.00 / $5,463.36 / $13,841.56
| Facility | | $1,653.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.97 / $916.97 / $5,269.19
| Professional | | $916.97 | $916.97 | $5,269.19 |
- 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
- $883.02 / $1,505.16 / $2,006.88
| Professional | | $883.02 | $1,505.16 | $2,006.88 |
- 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
- $1,453.00 / $2,238.35 / $3,010.70
| Professional | | $1,453.00 | $2,238.35 | $3,010.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $916.97 / $1,604.70 / $5,607.60
| Facility | | $916.97 | $1,604.70 | $5,607.60 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $255.18 / $646.16 / $646.16
| Facility | AS | $255.18 | $646.16 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,225.10 / $2,026.14 / $2,769.11
| Professional | | $1,225.10 | $2,026.14 | $2,769.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.00 / $2,197.38 / $3,010.70
| Facility | | $1,323.00 | $2,197.38 | $3,010.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.00 / $2,180.40 / $3,010.70
| Professional | | $1,323.00 | $2,180.40 | $3,010.70 |
- 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
- $1,225.10 / $2,125.21 / $2,638.69
| Professional | | $1,225.10 | $2,125.21 | $2,638.69 |