- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.97 / $3,412.15 / $9,062.00
| Facility | | $1,133.97 | $3,412.15 | $9,062.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.89 / $589.65 / $1,243.10
| Professional | | $252.89 | $589.65 | $1,243.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.34 / $352.44 / $427.99
| Professional | | $229.34 | $352.44 | $427.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,454.80 / $5,653.20 / $9,824.91
| Facility | | $1,454.80 | $5,653.20 | $9,824.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.66 / $437.59 / $873.65
| Professional | | $249.66 | $437.59 | $873.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,021.41 / $2,021.41 / $2,597.55
| Facility | | $2,021.41 | $2,021.41 | $2,597.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.92 / $656.46 / $1,504.66
| Professional | | $315.92 | $656.46 | $1,504.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.32 / $923.00 / $1,627.42
| Facility | | $315.32 | $923.00 | $1,627.42 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $64.15 / $138.60 / $227.84
| Facility | AS | $64.15 | $138.60 | $227.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,079.03 / $1,788.46 / $2,203.92
| Professional | | $1,079.03 | $1,788.46 | $2,203.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.55 / $739.30 / $1,177.57
| Professional | | $69.55 | $739.30 | $1,177.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $13,680.00 / $20,474.00
| Facility | | $2,155.00 | $13,680.00 | $20,474.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.77 / $1,113.64 / $2,076.84
| Professional | | $754.77 | $1,113.64 | $2,076.84 |