- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,311.00 / $7,745.20 / $23,675.00
| Facility | | $2,311.00 | $7,745.20 | $23,675.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,284.56 / $1,488.25 / $2,945.01
| Professional | | $1,284.56 | $1,488.25 | $2,945.01 |
- Facility/Professional
- Professional
- Modifier
- AS
- Low / Median / High Price
- $186.32 / $308.75 / $786.90
| Professional | AS | $186.32 | $308.75 | $786.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.36 / $1,745.17 / $2,483.89
| Professional | | $1,357.36 | $1,745.17 | $2,483.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,391.00 / $9,498.00 / $16,534.00
| Facility | | $3,391.00 | $9,498.00 | $16,534.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,405.87 / $1,930.90 / $3,069.07
| Professional | | $1,405.87 | $1,930.90 | $3,069.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $30.00 / $30.00 / $30.00
| Facility | | $30.00 | $30.00 | $30.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.40 / $2,060.65 / $3,107.51
| Professional | | $1,506.40 | $2,060.65 | $3,107.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $82,357.35 / $82,357.35
| Facility | | $55.00 | $82,357.35 | $82,357.35 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $365.73 / $7,806.31 / $7,806.31
| Facility | AS | $365.73 | $7,806.31 | $7,806.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,391.76 / $10,613.28 / $12,346.43
| Professional | | $10,391.76 | $10,613.28 | $12,346.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,052.00 / $12,700.00 / $29,000.00
| Facility | | $5,052.00 | $12,700.00 | $29,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,301.36 / $1,724.93 / $3,052.88
| Professional | | $1,301.36 | $1,724.93 | $3,052.88 |