- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,311.31 / $8,317.64
| Facility | | $478.63 | $3,311.31 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $602.56 / $1,380.38
| Professional | | $407.38 | $602.56 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $660.69 / $912.01
| Professional | | $467.74 | $660.69 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,230.27
| Professional | | $478.63 | $691.83 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,096.48
| Professional | | $489.78 | $676.08 | $1,096.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $812.83
| Facility | | $436.52 | $524.81 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.98 / $602.56 / $1,023.29
| Professional | | $3.98 | $602.56 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,244.36 / $10,471.29
| Facility | | $2,187.76 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $537.03 / $1,000.00
| Professional | | $407.38 | $537.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $6,760.83 / $6,760.83
| Facility | | $56.23 | $6,760.83 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $676.08 / $676.08 / $676.08
| Facility | AS | $676.08 | $676.08 | $676.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,801.89 / $3,801.89
| Professional | | $3,162.28 | $3,801.89 | $3,801.89 |