- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $3,548.13 / $4,365.16
| Facility | | $263.03 | $3,548.13 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $2,754.23 / $3,981.07
| Professional | | $234.42 | $2,754.23 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $5,128.61 / $8,912.51
| Professional | | $575.44 | $5,128.61 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $3,162.28 / $7,413.10
| Facility | | $309.03 | $3,162.28 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $6,760.83 / $22,908.68
| Professional | | $588.84 | $6,760.83 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $588.84 / $8,511.38
| Professional | | $562.34 | $588.84 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $7,413.10
| Professional | | $524.81 | $524.81 | $7,413.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $3,235.94 / $5,754.40
| Professional | | $416.87 | $3,235.94 | $5,754.40 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $1,412.54 / $1,412.54 / $1,412.54
| Professional | AS | $1,412.54 | $1,412.54 | $1,412.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,162.28 / $3,162.28 / $3,162.28
| Facility | | $3,162.28 | $3,162.28 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $707.95 / $9,772.37
| Professional | | $323.59 | $707.95 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $575.44 / $6,606.93
| Professional | | $467.74 | $575.44 | $6,606.93 |