- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,431.19 / $20,928.72
| Facility | | $5,463.36 | $10,431.19 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.77 / $653.77 / $3,861.89
| Professional | | $653.77 | $653.77 | $3,861.89 |
- 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
- $629.83 / $1,073.57 / $1,431.44
| Professional | | $629.83 | $1,073.57 | $1,431.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.44 / $1,631.08 / $2,196.48
| Professional | | $960.44 | $1,631.08 | $2,196.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $833.56 / $1,242.16 / $9,696.00
| Facility | | $833.56 | $1,242.16 | $9,696.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,618.01 / $1,618.01 / $1,618.01
| Facility | AS | $1,618.01 | $1,618.01 | $1,618.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.00 / $1,350.00 / $5,349.84
| Professional | | $900.00 | $1,350.00 | $5,349.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,141.63 / $1,699.60 / $5,718.15
| Facility | | $1,141.63 | $1,699.60 | $5,718.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,136.04 / $1,463.53 / $2,009.93
| Professional | | $1,136.04 | $1,463.53 | $2,009.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.30 / $1,241.95 / $1,419.70
| Professional | | $712.30 | $1,241.95 | $1,419.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $900.00 / $1,246.16 / $1,714.85
| Professional | | $900.00 | $1,246.16 | $1,714.85 |