- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,491.58 / $5,335.60 / $9,453.87
| Facility | | $1,491.58 | $5,335.60 | $9,453.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.51 / $1,122.54 / $1,469.60
| Professional | | $931.51 | $1,122.54 | $1,469.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $914.94 / $1,160.08 / $1,620.94
| Professional | | $914.94 | $1,160.08 | $1,620.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,328.66 / $19,332.08 / $30,159.63
| Facility | | $12,328.66 | $19,332.08 | $30,159.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.25 / $1,381.21 / $1,468.14
| Professional | | $1,027.25 | $1,381.21 | $1,468.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,659.86 / $5,659.86 / $5,659.86
| Facility | | $5,659.86 | $5,659.86 | $5,659.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.31 / $1,405.84 / $1,755.20
| Professional | | $1,033.31 | $1,405.84 | $1,755.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.54 / $1,570.00 / $13,541.98
| Facility | | $1,122.54 | $1,570.00 | $13,541.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $272.26 / $1,887.52 / $1,887.52
| Facility | AS | $272.26 | $1,887.52 | $1,887.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $948.20 / $1,227.08 / $7,887.28
| Professional | | $948.20 | $1,227.08 | $7,887.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,851.00 / $7,074.00 / $14,139.00
| Facility | | $1,851.00 | $7,074.00 | $14,139.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.42 / $1,115.53 / $1,583.83
| Professional | | $892.42 | $1,115.53 | $1,583.83 |