- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $5,370.32 / $9,772.37
| Facility | | $2,089.30 | $5,370.32 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,318.26 / $2,570.40
| Professional | | $1,023.29 | $1,318.26 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $954.99 / $1,174.90
| Professional | | $724.44 | $954.99 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $4,073.80 / $6,025.60
| Facility | | $1,258.93 | $4,073.80 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,412.54 / $2,818.38
| Professional | | $1,202.26 | $1,412.54 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $1,348.96
| Facility | | $1,047.13 | $1,348.96 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,230.27 / $2,344.23
| Professional | | $954.99 | $1,230.27 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $2,884.03 / $8,128.31
| Facility | | $1,071.52 | $2,884.03 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $269.15 / $269.15 / $1,122.02
| Facility | AS | $269.15 | $269.15 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,318.26 / $8,912.51
| Professional | | $977.24 | $1,318.26 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $5,623.41 / $8,709.64
| Facility | | $3,467.37 | $5,623.41 | $8,709.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $933.25 / $1,174.90 / $1,995.26
| Professional | | $933.25 | $1,174.90 | $1,995.26 |