- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $3,090.30 / $5,128.61
| Facility | | $1,047.13 | $3,090.30 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $3,630.78
| Professional | | $1,047.13 | $1,479.11 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $5,754.40 / $45,708.82
| Facility | | $2,398.83 | $5,754.40 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | 52 | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | AS | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,778.28 / $8,912.51
| Professional | | $1,047.13 | $1,778.28 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,862.09 / $3,467.37
| Professional | | $1,202.26 | $1,862.09 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,995.26 / $7,079.46
| Facility | | $575.44 | $1,995.26 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,548.82 / $2,187.76
| Professional | | $1,174.90 | $1,548.82 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $2,089.30 / $3,548.13
| Professional | | $1,174.90 | $2,089.30 | $3,548.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,818.38 / $5,754.40 / $45,708.82
| Facility | | $2,818.38 | $5,754.40 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- 52
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $8,912.51
| Facility | 52 | $8,912.51 | $8,912.51 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $1,122.02
| Facility | AS | $1,122.02 | $1,122.02 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,778.28 / $9,120.11
| Professional | | $1,023.29 | $1,778.28 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $11,220.18
| Facility | | $2,041.74 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,778.28 / $3,467.37
| Professional | | $1,202.26 | $1,778.28 | $3,467.37 |