- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $752.46 / $6,141.01 / $16,762.57
| Facility | | $752.46 | $6,141.01 | $16,762.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.45 / $952.37 / $2,993.19
| Professional | | $559.45 | $952.37 | $2,993.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.02 / $1,125.11 / $1,326.14
| Professional | | $153.02 | $1,125.11 | $1,326.14 |
- 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
- $594.00 / $1,147.50 / $1,931.10
| Professional | | $594.00 | $1,147.50 | $1,931.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,729.85 / $14,729.85 / $14,729.85
| Facility | | $14,729.85 | $14,729.85 | $14,729.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.83 / $1,856.24 / $2,913.83
| Professional | | $1,059.83 | $1,856.24 | $2,913.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.65 / $1,190.46 / $2,845.24
| Facility | | $659.65 | $1,190.46 | $2,845.24 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.97 / $275.97 / $275.97
| Facility | AS | $275.97 | $275.97 | $275.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.80 / $1,948.05 / $4,527.60
| Professional | | $1,198.80 | $1,948.05 | $4,527.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.55 / $2,007.71 / $14,729.85
| Facility | | $1,159.55 | $2,007.71 | $14,729.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.54 / $1,649.22 / $2,755.07
| Professional | | $1,177.54 | $1,649.22 | $2,755.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $636.78 / $1,116.53 / $2,022.12
| Professional | | $636.78 | $1,116.53 | $2,022.12 |
- 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
- $1,222.04 / $1,998.00 / $2,459.96
| Professional | | $1,222.04 | $1,998.00 | $2,459.96 |