- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,918.92 / $7,119.04 / $19,276.96
| Facility | | $2,918.92 | $7,119.04 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.42 / $742.85 / $2,779.00
| Professional | | $571.42 | $742.85 | $2,779.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.38 / $1,100.35 / $1,340.57
| Professional | | $541.38 | $1,100.35 | $1,340.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,916.13 / $9,096.60 / $17,595.75
| Facility | | $6,916.13 | $9,096.60 | $17,595.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.37 / $936.41 / $1,248.55
| Professional | | $549.37 | $936.41 | $1,248.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $838.88 / $1,422.69 / $1,923.70
| Professional | | $838.88 | $1,422.69 | $1,923.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.57 / $1,397.20 / $8,632.00
| Facility | | $728.57 | $1,397.20 | $8,632.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $854.12 / $854.12 / $854.12
| Facility | AS | $854.12 | $854.12 | $854.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.41 / $1,435.71 / $4,667.04
| Professional | | $790.41 | $1,435.71 | $4,667.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.22 / $1,547.77 / $3,018.60
| Facility | | $1,035.22 | $1,547.77 | $3,018.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.24 / $1,412.66 / $1,762.22
| Professional | | $1,000.24 | $1,412.66 | $1,762.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.98 / $1,082.73 / $1,237.90
| Professional | | $620.98 | $1,082.73 | $1,237.90 |
- 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
- $790.41 / $1,417.27 / $1,770.55
| Professional | | $790.41 | $1,417.27 | $1,770.55 |