- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.82 / $2,653.59 / $28,056.80
| Professional | | $1,380.82 | $2,653.59 | $28,056.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $12,735.73
| Facility | | $55.00 | $55.00 | $12,735.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $235.61 / $235.61 / $235.61
| Facility | AS | $235.61 | $235.61 | $235.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,318.12 / $22,057.47 / $55,711.16
| Professional | | $12,318.12 | $22,057.47 | $55,711.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.19 / $729.55 / $1,431.03
| Facility | | $561.19 | $729.55 | $1,431.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.55 / $9,519.16 / $19,768.43
| Professional | | $807.55 | $9,519.16 | $19,768.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.71 / $1,023.28 / $6,679.00
| Facility | | $484.71 | $1,023.28 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,519.52 / $11,282.17 / $20,023.82
| Professional | | $9,519.52 | $11,282.17 | $20,023.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.74 / $3,863.50 / $4,501.87
| Facility | | $2,951.74 | $3,863.50 | $4,501.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $395.36 / $790.72 / $969.34
| Professional | | $395.36 | $790.72 | $969.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $12,735.73
| Facility | | $55.00 | $55.00 | $12,735.73 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $235.61 / $235.61 / $235.61
| Facility | AS | $235.61 | $235.61 | $235.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,318.12 / $21,615.49 / $55,711.16
| Professional | | $12,318.12 | $21,615.49 | $55,711.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,175.66 / $15,321.35 / $31,063.11
| Professional | | $12,175.66 | $15,321.35 | $31,063.11 |