- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.65 / $6,408.55 / $16,762.57
| Facility | | $637.65 | $6,408.55 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.51 / $637.66 / $2,372.09
| Professional | | $428.51 | $637.66 | $2,372.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,362.84 / $10,999.42 / $21,276.43
| Facility | | $8,362.84 | $10,999.42 | $21,276.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.30 / $858.85 / $1,304.10
| Professional | | $457.30 | $858.85 | $1,304.10 |
- 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
- $879.81 / $1,335.18 / $1,981.84
| Professional | | $879.81 | $1,335.18 | $1,981.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.23 / $857.02 / $2,544.09
| Facility | | $510.23 | $857.02 | $2,544.09 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $213.75 / $213.75 / $213.75
| Facility | AS | $213.75 | $213.75 | $213.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.43 / $1,462.71 / $3,482.72
| Professional | | $884.43 | $1,462.71 | $3,482.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,027.64 / $1,499.27 / $2,842.49
| Facility | | $1,027.64 | $1,499.27 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $969.26 / $1,352.23 / $1,878.38
| Professional | | $969.26 | $1,352.23 | $1,878.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $492.91 / $859.43 / $1,380.38
| Professional | | $492.91 | $859.43 | $1,380.38 |
- 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
- $884.43 / $1,510.33 / $1,904.92
| Professional | | $884.43 | $1,510.33 | $1,904.92 |