- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,028.00 / $8,023.32 / $21,899.37
| Facility | | $4,028.00 | $8,023.32 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.33 / $2,079.69 / $3,069.59
| Professional | | $1,230.33 | $2,079.69 | $3,069.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,542.68 / $1,672.54 / $2,891.46
| Professional | | $1,542.68 | $1,672.54 | $2,891.46 |
- 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
- $1,188.68 / $2,026.16 / $2,701.55
| Professional | | $1,188.68 | $2,026.16 | $2,701.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,942.51 / $3,942.51 / $3,942.51
| Facility | | $3,942.51 | $3,942.51 | $3,942.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,580.34 / $3,015.90 / $4,007.62
| Professional | | $2,580.34 | $3,015.90 | $4,007.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,239.41 / $3,432.24 / $9,595.00
| Facility | | $1,239.41 | $3,432.24 | $9,595.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,413.06 / $1,413.06 / $1,413.06
| Facility | AS | $1,413.06 | $1,413.06 | $1,413.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,907.55 / $2,735.05 / $4,834.93
| Professional | | $1,907.55 | $2,735.05 | $4,834.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,477.09 / $3,502.09 / $5,256.68
| Facility | | $2,477.09 | $3,502.09 | $5,256.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,063.65 / $3,078.32 / $3,596.93
| Professional | | $2,063.65 | $3,078.32 | $3,596.93 |
- 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
- $2,134.67 / $2,957.74 / $3,710.69
| Professional | | $2,134.67 | $2,957.74 | $3,710.69 |