- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,164.41 / $6,345.10 / $13,841.56
| Facility | | $1,164.41 | $6,345.10 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.56 / $576.57 / $2,725.00
| Professional | | $331.56 | $576.57 | $2,725.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.16 / $1,090.64 / $1,290.52
| Professional | | $503.16 | $1,090.64 | $1,290.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,522.03 / $5,947.70 / $11,504.78
| Facility | | $4,522.03 | $5,947.70 | $11,504.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $525.75 / $896.17 / $1,194.90
| Professional | | $525.75 | $896.17 | $1,194.90 |
- 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
- $1,069.67 / $1,348.62 / $1,797.66
| Professional | | $1,069.67 | $1,348.62 | $1,797.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.11 / $1,031.91 / $8,957.00
| Facility | | $543.11 | $1,031.91 | $8,957.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $152.90 / $849.00 / $849.00
| Facility | AS | $152.90 | $849.00 | $849.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.26 / $1,139.79 / $1,669.24
| Professional | | $292.26 | $1,139.79 | $1,669.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,460.24 / $2,961.89
| Facility | | $1,089.00 | $1,460.24 | $2,961.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,045.78 / $1,305.40 / $1,797.66
| Professional | | $1,045.78 | $1,305.40 | $1,797.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.89 / $1,078.36 / $3,257.00
| Professional | | $591.89 | $1,078.36 | $3,257.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.86 / $1,256.70 / $1,636.63
| Professional | | $759.86 | $1,256.70 | $1,636.63 |