- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.99 / $3,908.01 / $13,841.56
| Facility | | $628.99 | $3,908.01 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.01 / $533.82 / $1,690.46
| Professional | | $297.01 | $533.82 | $1,690.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,906.94 / $7,769.24 / $15,028.22
| Facility | | $5,906.94 | $7,769.24 | $15,028.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.18 / $646.00 / $1,280.77
| Professional | | $316.18 | $646.00 | $1,280.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,387.40 / $1,387.40 / $1,387.40
| Facility | | $1,387.40 | $1,387.40 | $1,387.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.77 / $988.07 / $1,757.94
| Professional | | $604.77 | $988.07 | $1,757.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $356.21 / $828.69 / $2,312.52
| Facility | | $356.21 | $828.69 | $2,312.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $151.53 / $151.53 / $151.53
| Facility | AS | $151.53 | $151.53 | $151.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.78 / $1,181.57 / $2,643.33
| Professional | | $777.78 | $1,181.57 | $2,643.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $739.93 / $1,346.28 / $1,785.17
| Facility | | $739.93 | $1,346.28 | $1,785.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $675.56 / $1,031.44 / $1,730.63
| Professional | | $675.56 | $1,031.44 | $1,730.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,356.00 / $7,772.00
| Facility | | $3,711.00 | $5,356.00 | $7,772.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.78 / $1,196.58 / $1,591.34
| Professional | | $777.78 | $1,196.58 | $1,591.34 |