- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,005.00 / $8,477.27 / $20,928.72
| Facility | | $5,005.00 | $8,477.27 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $463.02 / $829.60 / $1,901.30
| Professional | | $463.02 | $829.60 | $1,901.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.54 / $1,672.54 / $1,951.35
| Professional | | $520.54 | $1,672.54 | $1,951.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,949.08 / $7,762.05 / $15,135.42
| Facility | | $5,949.08 | $7,762.05 | $15,135.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $802.77 / $1,368.38 / $1,824.51
| Professional | | $802.77 | $1,368.38 | $1,824.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,141.50 / $3,141.50 / $3,141.50
| Facility | | $3,141.50 | $3,141.50 | $3,141.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,742.66 / $2,042.02 / $2,704.07
| Professional | | $1,742.66 | $2,042.02 | $2,704.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $835.05 / $1,881.36 / $8,816.00
| Facility | | $835.05 | $1,881.36 | $8,816.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,125.97 / $1,125.97 / $1,125.97
| Facility | AS | $1,125.97 | $1,125.97 | $1,125.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,280.82 / $1,758.34 / $2,650.56
| Professional | | $1,280.82 | $1,758.34 | $2,650.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.00 / $2,323.73 / $4,133.42
| Facility | | $1,285.00 | $2,323.73 | $4,133.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.00 / $1,930.84 / $2,362.35
| Professional | | $1,383.00 | $1,930.84 | $2,362.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,358.52 / $1,989.88 / $2,390.86
| Professional | | $1,358.52 | $1,989.88 | $2,390.86 |