- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,083.97 / $8,477.27 / $19,276.96
| Facility | | $4,083.97 | $8,477.27 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.88 / $402.20 / $2,059.37
| Professional | | $322.88 | $402.20 | $2,059.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,094.34 / $5,385.17 / $10,416.66
| Facility | | $4,094.34 | $5,385.17 | $10,416.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.88 / $637.28 / $849.72
| Professional | | $373.88 | $637.28 | $849.72 |
- 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
- $591.00 / $933.34 / $1,251.27
| Professional | | $591.00 | $933.34 | $1,251.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.02 / $673.79 / $4,017.35
| Facility | | $385.02 | $673.79 | $4,017.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $108.73 / $380.79 / $380.79
| Facility | AS | $108.73 | $380.79 | $380.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.60 / $844.46 / $1,158.05
| Professional | | $510.60 | $844.46 | $1,158.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.97 / $1,042.55 / $1,346.60
| Facility | | $592.97 | $1,042.55 | $1,346.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.97 / $926.82 / $1,251.27
| Professional | | $592.97 | $926.82 | $1,251.27 |
- 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
- $510.60 / $887.50 / $1,099.76
| Professional | | $510.60 | $887.50 | $1,099.76 |