- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.10 / $1,599.81 / $7,439.00
| Facility | | $985.10 | $1,599.81 | $7,439.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $976.96 / $1,028.82 / $1,978.94
| Professional | | $976.96 | $1,028.82 | $1,978.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,200.33 / $2,033.32 / $2,723.93
| Professional | | $1,200.33 | $2,033.32 | $2,723.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $606.10 / $606.10 / $2,062.80
| Facility | | $606.10 | $606.10 | $2,062.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,118.00 / $1,480.24 / $2,568.81
| Professional | | $1,118.00 | $1,480.24 | $2,568.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.10 / $1,324.02 / $1,940.21
| Facility | | $985.10 | $1,324.02 | $1,940.21 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $181.51 / $185.36 / $325.48
| Facility | AS | $181.51 | $185.36 | $325.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,273.00 / $1,273.00 / $1,324.02
| Professional | | $1,273.00 | $1,273.00 | $1,324.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $1,304.00 / $2,785.10
| Professional | | $5.00 | $1,304.00 | $2,785.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,661.00 / $7,659.00 / $10,502.00
| Facility | | $1,661.00 | $7,659.00 | $10,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $892.37 / $1,222.84 / $2,456.21
| Professional | | $892.37 | $1,222.84 | $2,456.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,880.98 / $6,880.98
| Facility | | $55.00 | $6,880.98 | $6,880.98 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $227.13 / $388.48 / $646.16
| Facility | AS | $227.13 | $388.48 | $646.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,241.20 / $8,566.95 / $8,566.95
| Professional | | $7,241.20 | $8,566.95 | $8,566.95 |