- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $6,165.95 / $13,182.57
| Facility | | $1,288.25 | $6,165.95 | $13,182.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $812.83 / $2,344.23
| Professional | | $323.59 | $812.83 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $389.05 / $630.96
| Professional | | $281.84 | $389.05 | $630.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $19,952.62 / $47,863.01
| Facility | | $1,548.82 | $19,952.62 | $47,863.01 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | 53 | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $56.23 / $56.23 / $56.23
| Facility | AS | $56.23 | $56.23 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $741.31 / $1,737.80
| Professional | | $331.13 | $741.31 | $1,737.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $8,317.64 / $16,595.87
| Facility | | $4,365.16 | $8,317.64 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $691.83 / $1,202.26
| Professional | | $660.69 | $691.83 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $912.01
| Professional | | $32.36 | $33.11 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $8,128.31 / $12,302.69
| Facility | | $2,630.27 | $8,128.31 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $870.96 / $1,862.09
| Professional | | $323.59 | $870.96 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $251.19 / $512.86
| Professional | | $251.19 | $251.19 | $512.86 |