- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,513.60 / $6,676.00 / $16,762.57
| Facility | | $1,513.60 | $6,676.00 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.18 / $429.78 / $1,161.00
| Professional | | $367.18 | $429.78 | $1,161.00 |
- 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
- $367.24 / $625.97 / $834.63
| Professional | | $367.24 | $625.97 | $834.63 |
- 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
- $580.00 / $918.93 / $1,231.94
| Professional | | $580.00 | $918.93 | $1,231.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.16 / $697.60 / $4,017.35
| Facility | | $379.16 | $697.60 | $4,017.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $106.93 / $380.79 / $380.79
| Facility | AS | $106.93 | $380.79 | $380.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $504.26 / $833.96 / $1,143.46
| Professional | | $504.26 | $833.96 | $1,143.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.00 / $1,025.93 / $1,331.66
| Facility | | $530.00 | $1,025.93 | $1,331.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.00 / $910.49 / $1,231.94
| Professional | | $530.00 | $910.49 | $1,231.94 |
- 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
- $504.26 / $833.96 / $1,086.08
| Professional | | $504.26 | $833.96 | $1,086.08 |