- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.58 / $6,408.55 / $19,276.96
| Facility | | $609.58 | $6,408.55 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.70 / $566.44 / $1,958.00
| Professional | | $408.70 | $566.44 | $1,958.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,003.91 / $9,212.06 / $17,819.09
| Facility | | $7,003.91 | $9,212.06 | $17,819.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $460.04 / $844.26 / $1,244.08
| Professional | | $460.04 | $844.26 | $1,244.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $823.62 / $1,276.66 / $1,892.24
| Professional | | $823.62 | $1,276.66 | $1,892.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.25 / $821.96 / $2,213.08
| Facility | | $513.25 | $821.96 | $2,213.08 |
- 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
- $813.32 / $1,345.10 / $3,509.84
| Professional | | $813.32 | $1,345.10 | $3,509.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,037.83 / $1,437.39 / $2,842.49
| Facility | | $1,037.83 | $1,437.39 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.95 / $1,242.20 / $1,769.06
| Professional | | $958.95 | $1,242.20 | $1,769.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.32 / $1,251.26 / $1,751.76
| Professional | | $813.32 | $1,251.26 | $1,751.76 |