- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $933.25 / $20,892.96 / $25,703.96
| Facility | | $933.25 | $20,892.96 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.01 / $1,047.13 / $2,238.72
| Professional | | $912.01 | $1,047.13 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $15,135.61 / $34,673.69
| Facility | | $6,165.95 | $15,135.61 | $34,673.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,344.23 / $3,801.89
| Professional | | $1,621.81 | $2,344.23 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $3,467.37 / $8,317.64
| Facility | | $2,454.71 | $3,467.37 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $173.78 / $173.78 / $173.78
| Facility | AS | $173.78 | $173.78 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,951.21 / $4,466.84
| Professional | | $1,949.84 | $2,951.21 | $4,466.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,311.31 / $6,456.54
| Facility | | $2,630.27 | $3,311.31 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,511.89 / $3,715.35
| Professional | | $1,778.28 | $2,511.89 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,905.46 / $12,302.69
| Facility | | $1,230.27 | $1,905.46 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,089.30 / $5,495.41
| Professional | | $1,122.02 | $2,089.30 | $5,495.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $6,760.83 / $12,882.50
| Facility | | $1,584.89 | $6,760.83 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,949.84 / $3,890.45
| Professional | | $1,122.02 | $1,949.84 | $3,890.45 |