- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.64 / $7,119.04 / $16,762.57
| Facility | | $801.64 | $7,119.04 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.52 / $991.24 / $2,049.00
| Professional | | $410.52 | $991.24 | $2,049.00 |
- 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
- $408.61 / $696.50 / $928.65
| Professional | | $408.61 | $696.50 | $928.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.42 / $1,062.42 / $1,062.42
| Facility | | $1,062.42 | $1,062.42 | $1,062.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.00 / $1,028.55 / $1,378.89
| Professional | | $653.00 | $1,028.55 | $1,378.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $421.92 / $774.88 / $4,017.35
| Facility | | $421.92 | $774.88 | $4,017.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $118.78 / $380.79 / $380.79
| Facility | AS | $118.78 | $380.79 | $380.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.67 / $932.24 / $1,276.04
| Professional | | $563.67 | $932.24 | $1,276.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.57 / $1,062.42 / $1,434.09
| Facility | | $700.57 | $1,062.42 | $1,434.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $700.57 / $1,014.35 / $1,378.89
| Professional | | $700.57 | $1,014.35 | $1,378.89 |
- 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
- $563.67 / $980.68 / $1,238.80
| Professional | | $563.67 | $980.68 | $1,238.80 |