- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $771.11 / $8,042.03 / $19,276.96
| Facility | | $771.11 | $8,042.03 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.15 / $771.11 / $2,507.38
| Professional | | $469.15 | $771.11 | $2,507.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.85 / $1,123.85 / $5,181.28
| Professional | | $1,123.85 | $1,123.85 | $5,181.28 |
- 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
- $502.26 / $960.59 / $1,579.33
| Professional | | $502.26 | $960.59 | $1,579.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,648.45 / $6,648.45 / $6,648.45
| Facility | | $6,648.45 | $6,648.45 | $6,648.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $883.35 / $1,549.45 / $2,391.84
| Professional | | $883.35 | $1,549.45 | $2,391.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $558.83 / $938.30 / $2,406.00
| Facility | | $558.83 | $938.30 | $2,406.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $233.88 / $233.88 / $233.88
| Facility | AS | $233.88 | $233.88 | $233.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $980.00 / $1,566.96 / $4,081.00
| Professional | | $980.00 | $1,566.96 | $4,081.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,124.44 / $1,804.21 / $7,978.14
| Facility | | $1,124.44 | $1,804.21 | $7,978.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,029.58 / $1,432.43 / $2,229.04
| Professional | | $1,029.58 | $1,432.43 | $2,229.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.65 / $940.93 / $1,661.13
| Professional | | $539.65 | $940.93 | $1,661.13 |
- 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
- $981.57 / $1,783.93 / $1,991.78
| Professional | | $981.57 | $1,783.93 | $1,991.78 |