- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.78 / $913.93 / $6,955.00
| Facility | | $518.78 | $913.93 | $6,955.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $488.01 / $741.19 / $1,853.75
| Professional | | $488.01 | $741.19 | $1,853.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,539.21 / $5,396.85 / $11,503.06
| Facility | | $2,539.21 | $5,396.85 | $11,503.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,008.13 / $1,767.17 / $3,106.00
| Professional | | $1,008.13 | $1,767.17 | $3,106.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,220.44 / $3,155.70 / $7,591.46
| Facility | | $2,220.44 | $3,155.70 | $7,591.46 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $88.21 / $88.21 / $88.21
| Facility | AS | $88.21 | $88.21 | $88.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.73 / $2,021.61 / $3,623.25
| Professional | | $1,102.73 | $2,021.61 | $3,623.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.92 / $2,885.06 / $5,977.53
| Facility | | $2,021.92 | $2,885.06 | $5,977.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.26 / $1,905.32 / $3,435.90
| Professional | | $1,115.26 | $1,905.32 | $3,435.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.72 / $1,171.81 / $3,190.00
| Facility | | $718.72 | $1,171.81 | $3,190.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $237.82 / $237.82 / $237.82
| Facility | AS | $237.82 | $237.82 | $237.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.44 / $1,852.81 / $4,785.00
| Professional | | $978.44 | $1,852.81 | $4,785.00 |
- 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
- $973.17 / $1,689.07 / $3,448.63
| Professional | | $973.17 | $1,689.07 | $3,448.63 |