- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $446.08 / $3,795.64 / $12,765.09
| Facility | | $446.08 | $3,795.64 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.24 / $446.08 / $1,556.10
| Professional | | $316.24 | $446.08 | $1,556.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.64 / $566.64 / $643.84
| Professional | | $566.64 | $566.64 | $643.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.19 / $615.13 / $904.98
| Professional | | $335.19 | $615.13 | $904.98 |
- 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
- $583.39 / $963.53 / $1,355.63
| Professional | | $583.39 | $963.53 | $1,355.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.15 / $723.26 / $1,601.68
| Facility | | $371.15 | $723.26 | $1,601.68 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $154.86 / $154.86 / $154.86
| Facility | AS | $154.86 | $154.86 | $154.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.02 / $1,028.39 / $2,553.36
| Professional | | $614.02 | $1,028.39 | $2,553.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.53 / $1,061.98 / $2,163.42
| Facility | | $744.53 | $1,061.98 | $2,163.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $684.75 / $925.27 / $1,314.69
| Professional | | $684.75 | $925.27 | $1,314.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,562.76 / $4,236.79 / $7,772.00
| Facility | | $3,562.76 | $4,236.79 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.99 / $1,048.55 / $1,322.50
| Professional | | $578.99 | $1,048.55 | $1,322.50 |