- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,741.00 / $10,175.36 / $13,413.92
| Facility | | $3,741.00 | $10,175.36 | $13,413.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.12 / $2,070.38 / $7,117.36
| Professional | | $168.12 | $2,070.38 | $7,117.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $533.74 / $533.74 / $5,478.40
| Professional | | $533.74 | $533.74 | $5,478.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.17 / $1,085.67 / $9,964.29
| Facility | | $196.17 | $1,085.67 | $9,964.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.96 / $1,283.88 / $9,880.50
| Professional | | $459.96 | $1,283.88 | $9,880.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.85 / $1,014.65 / $11,414.00
| Professional | | $635.85 | $1,014.65 | $11,414.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.17 / $1,085.67 / $9,964.29
| Facility | | $196.17 | $1,085.67 | $9,964.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.54 / $1,616.63 / $11,674.00
| Professional | | $348.54 | $1,616.63 | $11,674.00 |
- Facility/Professional
- Professional
- Modifier
- 80
- Low / Median / High Price
- $607.74 / $607.74 / $706.73
| Professional | 80 | $607.74 | $607.74 | $706.73 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $516.58 / $516.58 / $600.72
| Professional | AS | $516.58 | $516.58 | $600.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,268.13 / $4,382.72 / $10,701.95
| Professional | | $4,268.13 | $4,382.72 | $10,701.95 |