- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $6,760.83 / $14,791.08
| Facility | | $1,230.27 | $6,760.83 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,230.27 / $2,570.40
| Professional | | $870.96 | $1,230.27 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,023.29 / $1,659.59
| Professional | | $851.14 | $1,023.29 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $12,589.25 / $53,703.18
| Facility | | $1,949.84 | $12,589.25 | $53,703.18 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $169.82 / $169.82 / $169.82
| Facility | AS | $169.82 | $169.82 | $169.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $758.58 / $1,318.26 / $2,818.38
| Professional | | $758.58 | $1,318.26 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,165.95 / $12,022.64 / $22,908.68
| Facility | | $6,165.95 | $12,022.64 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $660.69 / $1,318.26
| Professional | | $616.60 | $660.69 | $1,318.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,023.29
| Professional | | $32.36 | $33.11 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $10,232.93 / $15,848.93
| Facility | | $3,235.94 | $10,232.93 | $15,848.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.83 / $1,122.02 / $1,905.46
| Professional | | $812.83 | $1,122.02 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $776.25 / $1,000.00
| Professional | | $776.25 | $776.25 | $1,000.00 |