- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.78 / $6,696.86 / $8,860.00
| Facility | | $1,056.78 | $6,696.86 | $8,860.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.67 / $1,444.92 / $7,661.92
| Professional | | $972.67 | $1,444.92 | $7,661.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,336.82 / $11,253.87 / $25,424.06
| Facility | | $2,336.82 | $11,253.87 | $25,424.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,866.69 / $3,008.25 / $3,925.32
| Professional | | $1,866.69 | $3,008.25 | $3,925.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,563.37 / $3,637.05 / $8,749.43
| Facility | | $2,563.37 | $3,637.05 | $8,749.43 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $120.27 / $120.27 / $120.27
| Facility | AS | $120.27 | $120.27 | $120.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,920.60 / $3,059.47 / $4,543.78
| Professional | | $1,920.60 | $3,059.47 | $4,543.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,330.34 / $3,325.14 / $6,889.31
| Facility | | $2,330.34 | $3,325.14 | $6,889.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.85 / $2,735.37 / $4,166.91
| Professional | | $1,738.85 | $2,735.37 | $4,166.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.86 / $2,382.91 / $9,018.83
| Facility | | $1,312.86 | $2,382.91 | $9,018.83 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $272.26 / $272.26 / $814.27
| Facility | AS | $272.26 | $272.26 | $814.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,302.79 / $2,599.58 / $5,229.45
| Professional | | $1,302.79 | $2,599.58 | $5,229.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,577.00 / $9,370.00 / $12,774.00
| Facility | | $5,577.00 | $9,370.00 | $12,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,139.92 / $2,072.58 / $4,071.68
| Professional | | $1,139.92 | $2,072.58 | $4,071.68 |