- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.46 / $3,105.00 / $7,602.00
| Facility | | $1,200.46 | $3,105.00 | $7,602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,158.58 / $1,402.46 / $2,756.07
| Professional | | $1,158.58 | $1,402.46 | $2,756.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,132.00 / $3,611.00 / $5,774.00
| Facility | | $2,132.00 | $3,611.00 | $5,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.36 / $1,619.22 / $2,361.13
| Professional | | $1,228.36 | $1,619.22 | $2,361.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,240.32 / $1,652.22 / $2,919.54
| Professional | | $1,240.32 | $1,652.22 | $2,919.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,979.65 / $11,102.00 / $26,542.00
| Facility | | $6,979.65 | $11,102.00 | $26,542.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $2,353.26 / $6,576.94 / $6,576.94
| Facility | 62 | $2,353.26 | $6,576.94 | $6,576.94 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $376.52 / $1,052.31 / $1,052.31
| Facility | AS | $376.52 | $1,052.31 | $1,052.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,949.44 / $12,056.47 / $12,846.15
| Professional | | $10,949.44 | $12,056.47 | $12,846.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $4,463.00 / $7,604.00
| Facility | | $2,000.00 | $4,463.00 | $7,604.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,393.85 / $1,652.56 / $3,005.73
| Professional | | $1,393.85 | $1,652.56 | $3,005.73 |