- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $3,090.30 / $7,762.47
| Facility | | $1,096.48 | $3,090.30 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $812.83 / $2,187.76
| Professional | | $323.59 | $812.83 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $398.11 / $831.76
| Professional | | $281.84 | $398.11 | $831.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $4,073.80 / $5,888.44
| Facility | | $1,905.46 | $4,073.80 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,071.52 / $2,238.72
| Professional | | $407.38 | $1,071.52 | $2,238.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $12,302.69
| Facility | | $2,089.30 | $2,089.30 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $398.11 / $1,000.00 / $2,089.30
| Professional | | $398.11 | $1,000.00 | $2,089.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,912.51 / $8,912.51 / $45,708.82
| Facility | | $8,912.51 | $8,912.51 | $45,708.82 |
- Facility/Professional
- Facility
- Modifier
- 53
- Low / Median / High Price
- $1,819.70 / $1,819.70 / $1,819.70
| Facility | 53 | $1,819.70 | $1,819.70 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Facility | AS | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,762.47 / $7,762.47 / $7,943.28
| Professional | | $7,762.47 | $7,762.47 | $7,943.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $4,786.30 / $15,488.17
| Facility | | $2,754.23 | $4,786.30 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $1,000.00 / $2,137.96
| Professional | | $371.54 | $1,000.00 | $2,137.96 |