- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,163.08 / $5,463.36 / $13,841.56
| Facility | | $2,163.08 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.03 / $774.68 / $1,707.87
| Professional | | $236.03 | $774.68 | $1,707.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,092.34 / $8,013.10 / $15,499.92
| Facility | | $6,092.34 | $8,013.10 | $15,499.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $247.59 / $562.72 / $1,525.00
| Professional | | $247.59 | $562.72 | $1,525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.95 / $917.90 / $2,190.31
| Professional | | $558.95 | $917.90 | $2,190.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.05 / $1,316.96 / $5,243.53
| Facility | | $354.05 | $1,316.96 | $5,243.53 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $116.26 / $116.26 / $116.26
| Facility | AS | $116.26 | $116.26 | $116.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.94 / $1,606.21 / $3,050.66
| Professional | | $989.94 | $1,606.21 | $3,050.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.64 / $1,716.14 / $3,018.51
| Facility | | $606.64 | $1,716.14 | $3,018.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.95 / $1,461.58 / $2,190.31
| Professional | | $558.95 | $1,461.58 | $2,190.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.33 / $512.16 / $1,573.31
| Professional | | $266.33 | $512.16 | $1,573.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,441.00 / $8,816.00
| Facility | | $5,341.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $989.94 / $1,690.51 / $2,092.85
| Professional | | $989.94 | $1,690.51 | $2,092.85 |