- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.32 / $4,182.08 / $12,765.09
| Facility | | $527.32 | $4,182.08 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.24 / $517.86 / $1,890.59
| Professional | | $322.24 | $517.86 | $1,890.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.21 / $117.21 / $117.21
| Professional | | $117.21 | $117.21 | $117.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.44 / $718.08 / $1,082.35
| Professional | | $384.44 | $718.08 | $1,082.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.54 / $1,110.71 / $1,647.80
| Professional | | $612.54 | $1,110.71 | $1,647.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.20 / $694.74 / $2,094.50
| Facility | | $428.20 | $694.74 | $2,094.50 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $179.69 / $179.69 / $179.69
| Facility | AS | $179.69 | $179.69 | $179.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $663.85 / $1,134.81 / $2,928.16
| Professional | | $663.85 | $1,134.81 | $2,928.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.89 / $1,244.54 / $2,842.49
| Facility | | $863.89 | $1,244.54 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.74 / $1,066.26 / $1,525.26
| Professional | | $771.74 | $1,066.26 | $1,525.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $705.71 / $1,167.13 / $1,519.98
| Professional | | $705.71 | $1,167.13 | $1,519.98 |