- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,445.44 / $5,754.40 / $11,481.54
| Facility | | $1,445.44 | $5,754.40 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $724.44 / $2,691.53
| Professional | | $489.78 | $724.44 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $407.38 / $691.83
| Professional | | $407.38 | $407.38 | $691.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,317.64 / $10,964.78 / $21,379.62
| Facility | | $8,317.64 | $10,964.78 | $21,379.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $912.01 / $1,348.96
| Professional | | $549.54 | $912.01 | $1,348.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,318.26 / $2,089.30
| Professional | | $794.33 | $1,318.26 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $851.14 / $4,073.80
| Facility | | $575.44 | $851.14 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.87 / $223.87 / $223.87
| Facility | AS | $223.87 | $223.87 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,380.38 / $5,248.07
| Professional | | $758.58 | $1,380.38 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,479.11 / $2,137.96
| Professional | | $1,071.52 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,454.71
| Facility | | $2,454.71 | $2,454.71 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,479.11 / $2,137.96
| Professional | | $1,096.48 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,073.80 / $5,495.41 / $8,912.51
| Facility | | $4,073.80 | $5,495.41 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,047.13 / $1,698.24
| Professional | | $575.44 | $1,047.13 | $1,698.24 |