- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.52 / $2,522.96 / $11,111.80
| Professional | | $1,312.52 | $2,522.96 | $11,111.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $4,897.51
| Facility | | $55.00 | $55.00 | $4,897.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.74 / $223.74 / $223.74
| Facility | AS | $223.74 | $223.74 | $223.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,000.91 / $9,729.81 / $23,800.94
| Professional | | $5,000.91 | $9,729.81 | $23,800.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.90 / $692.77 / $1,358.90
| Facility | | $532.90 | $692.77 | $1,358.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $679.98 / $2,962.34 / $7,476.12
| Professional | | $679.98 | $2,962.34 | $7,476.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.35 / $971.68 / $6,679.00
| Facility | | $460.35 | $971.68 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,622.22 / $4,266.74 / $7,619.15
| Professional | | $3,622.22 | $4,266.74 | $7,619.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,971.48 / $12,509.51 / $13,467.61
| Facility | | $2,971.48 | $12,509.51 | $13,467.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.71 / $1,081.50 / $1,625.15
| Professional | | $367.71 | $1,081.50 | $1,625.15 |
- Facility/Professional
- Professional
- Modifier
- 50
- Low / Median / High Price
- $551.55 / $551.55 / $551.55
| Professional | 50 | $551.55 | $551.55 | $551.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $4,897.51
| Facility | | $55.00 | $55.00 | $4,897.51 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $223.74 / $223.74 / $223.74
| Facility | AS | $223.74 | $223.74 | $223.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,000.91 / $8,836.62 / $23,800.94
| Professional | | $5,000.91 | $8,836.62 | $23,800.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,762.75 / $8,049.93 / $14,563.74
| Professional | | $4,762.75 | $8,049.93 | $14,563.74 |