- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $543.25 / $6,024.00 / $8,262.03
| Facility | | $543.25 | $6,024.00 | $8,262.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.24 / $652.42 / $2,843.83
| Professional | | $302.24 | $652.42 | $2,843.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,667.71 / $5,396.85 / $11,503.06
| Facility | | $2,667.71 | $5,396.85 | $11,503.06 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $6,310.01 / $11,198.08 / $19,634.84
| Facility | 50 | $6,310.01 | $11,198.08 | $19,634.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.30 / $1,534.17 / $2,007.68
| Professional | | $960.30 | $1,534.17 | $2,007.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,323.36 / $1,877.65 / $4,516.95
| Facility | | $1,323.36 | $1,877.65 | $4,516.95 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $61.52 / $61.52 / $61.52
| Facility | AS | $61.52 | $61.52 | $61.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $993.46 / $1,582.55 / $2,350.33
| Professional | | $993.46 | $1,582.55 | $2,350.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,203.05 / $1,716.62 / $3,556.65
| Facility | | $1,203.05 | $1,716.62 | $3,556.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $899.44 / $1,414.91 / $2,155.39
| Professional | | $899.44 | $1,414.91 | $2,155.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $744.46 / $1,490.19 / $6,199.22
| Facility | | $744.46 | $1,490.19 | $6,199.22 |
- Facility/Professional
- Facility
- Modifier
- 50
- Low / Median / High Price
- $3,692.42 / $3,692.42 / $6,421.05
| Facility | 50 | $3,692.42 | $3,692.42 | $6,421.05 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $140.08 / $140.08 / $814.27
| Facility | AS | $140.08 | $140.08 | $814.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $619.29 / $1,320.16 / $2,607.62
| Professional | | $619.29 | $1,320.16 | $2,607.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,121.00 / $5,499.00 / $9,810.00
| Facility | | $3,121.00 | $5,499.00 | $9,810.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.59 / $1,060.28 / $2,054.94
| Professional | | $614.59 | $1,060.28 | $2,054.94 |