- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.21 / $1,037.96 / $7,019.76
| Facility | | $596.21 | $1,037.96 | $7,019.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.21 / $911.49 / $1,595.93
| Professional | | $596.21 | $911.49 | $1,595.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,878.46 / $11,253.87 / $25,424.06
| Facility | | $2,878.46 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,160.66 / $2,049.37 / $3,562.70
| Professional | | $1,160.66 | $2,049.37 | $3,562.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,534.75 / $3,596.44 / $8,651.73
| Facility | | $2,534.75 | $3,596.44 | $8,651.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $101.87 / $101.87 / $101.87
| Facility | AS | $101.87 | $101.87 | $101.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,274.75 / $2,306.44 / $4,169.22
| Professional | | $1,274.75 | $2,306.44 | $4,169.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,061.63 / $3,288.01 / $6,812.39
| Facility | | $2,061.63 | $3,288.01 | $6,812.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.31 / $2,173.77 / $3,919.99
| Professional | | $1,283.31 | $2,173.77 | $3,919.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.92 / $1,368.70 / $3,991.00
| Facility | | $826.92 | $1,368.70 | $3,991.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $275.06 / $275.06 / $275.06
| Facility | AS | $275.06 | $275.06 | $275.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,102.72 / $2,072.17 / $5,137.00
| Professional | | $1,102.72 | $2,072.17 | $5,137.00 |
- 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
- $1,118.33 / $1,953.16 / $3,889.79
| Professional | | $1,118.33 | $1,953.16 | $3,889.79 |