- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $5,011.87 / $10,964.78
| Facility | | $1,023.29 | $5,011.87 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $524.81 / $1,445.44
| Professional | | $309.03 | $524.81 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $295.12 / $295.12
| Professional | | $295.12 | $295.12 | $295.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,025.60 / $11,748.98
| Facility | | $4,570.88 | $6,025.60 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $891.25
| Professional | | $363.08 | $588.84 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $776.25 / $1,380.38
| Professional | | $354.81 | $776.25 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.19 / $707.95 / $3,019.95
| Facility | | $380.19 | $707.95 | $3,019.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.88 / $154.88 / $154.88
| Facility | AS | $154.88 | $154.88 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $831.76 / $2,454.71
| Professional | | $549.54 | $831.76 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,000.00 / $1,258.93
| Professional | | $741.31 | $1,000.00 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $724.44 / $1,023.29
| Professional | | $724.44 | $724.44 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $602.56 / $1,258.93
| Professional | | $3.98 | $602.56 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,162.28 / $8,128.31
| Facility | | $2,041.74 | $3,162.28 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $691.83 / $1,096.48
| Professional | | $446.68 | $691.83 | $1,096.48 |