- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $873.60 / $6,408.55 / $16,762.57
| Facility | | $873.60 | $6,408.55 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $366.33 / $818.24 / $1,740.00
| Professional | | $366.33 | $818.24 | $1,740.00 |
- 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
- $355.39 / $605.79 / $807.73
| Professional | | $355.39 | $605.79 | $807.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,802.85 / $1,802.85 / $1,802.85
| Facility | | $1,802.85 | $1,802.85 | $1,802.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.00 / $890.00 / $1,193.14
| Professional | | $563.00 | $890.00 | $1,193.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $366.33 / $659.39 / $4,767.99
| Facility | | $366.33 | $659.39 | $4,767.99 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $103.38 / $646.16 / $646.16
| Facility | AS | $103.38 | $646.16 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.53 / $806.29 / $1,105.50
| Professional | | $487.53 | $806.29 | $1,105.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.75 / $992.22 / $2,256.42
| Facility | | $605.75 | $992.22 | $2,256.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $605.75 / $881.60 / $1,193.14
| Professional | | $605.75 | $881.60 | $1,193.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,356.00 / $7,772.00
| Facility | | $3,711.00 | $5,356.00 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.53 / $822.83 / $1,050.06
| Professional | | $487.53 | $822.83 | $1,050.06 |