- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $471.02 / $674.46 / $6,696.86
| Facility | | $471.02 | $674.46 | $6,696.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.23 / $635.01 / $1,043.10
| Professional | | $433.23 | $635.01 | $1,043.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,206.67 / $7,465.39 / $14,249.16
| Facility | | $4,206.67 | $7,465.39 | $14,249.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.84 / $1,530.88 / $2,326.26
| Professional | | $881.84 | $1,530.88 | $2,326.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.73 / $2,327.94 / $5,600.21
| Facility | | $1,640.73 | $2,327.94 | $5,600.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $79.52 / $79.52 / $79.52
| Facility | AS | $79.52 | $79.52 | $79.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.39 / $1,612.58 / $2,795.47
| Professional | | $993.39 | $1,612.58 | $2,795.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,491.57 / $2,128.31 / $4,409.60
| Facility | | $1,491.57 | $2,128.31 | $4,409.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $957.12 / $1,508.16 / $2,549.05
| Professional | | $957.12 | $1,508.16 | $2,549.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.25 / $960.00 / $2,451.84
| Facility | | $519.25 | $960.00 | $2,451.84 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $215.87 / $215.87 / $215.87
| Facility | AS | $215.87 | $215.87 | $215.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.47 / $1,346.07 / $3,509.84
| Professional | | $734.47 | $1,346.07 | $3,509.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.47 / $1,255.20 / $2,518.12
| Professional | | $734.47 | $1,255.20 | $2,518.12 |