- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,862.05 / $8,023.41 / $19,276.96
| Facility | | $4,862.05 | $8,023.41 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $327.06 / $925.47 / $1,689.00
| Professional | | $327.06 | $925.47 | $1,689.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.73 / $939.73 / $939.73
| Professional | | $939.73 | $939.73 | $939.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,609.82 / $6,247.48 / $11,728.12
| Facility | | $4,609.82 | $6,247.48 | $11,728.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.47 / $651.94 / $869.25
| Professional | | $382.47 | $651.94 | $869.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $797.03 / $990.49 / $1,288.20
| Professional | | $797.03 | $990.49 | $1,288.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $437.83 / $750.65 / $6,817.20
| Facility | | $437.83 | $750.65 | $6,817.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $646.16 / $646.16 / $646.16
| Facility | AS | $646.16 | $646.16 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.16 / $984.91 / $3,228.96
| Professional | | $526.16 | $984.91 | $3,228.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.03 / $1,070.23 / $2,256.42
| Facility | | $797.03 | $1,070.23 | $2,256.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.39 / $979.61 / $1,288.20
| Professional | | $653.39 | $979.61 | $1,288.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4.00 / $555.90 / $1,124.59
| Professional | | $4.00 | $555.90 | $1,124.59 |
- 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
- $607.11 / $943.21 / $1,191.48
| Professional | | $607.11 | $943.21 | $1,191.48 |