- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.79 / $2,769.13 / $13,647.50
| Professional | | $1,437.79 | $2,769.13 | $13,647.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $7,143.30
| Facility | | $55.00 | $55.00 | $7,143.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.87 / $245.87 / $245.87
| Facility | AS | $245.87 | $245.87 | $245.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,758.78 / $11,887.35 / $28,088.65
| Professional | | $6,758.78 | $11,887.35 | $28,088.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.35 / $760.96 / $1,492.64
| Facility | | $585.35 | $760.96 | $1,492.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $826.81 / $3,253.90 / $8,690.15
| Professional | | $826.81 | $3,253.90 | $8,690.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.78 / $1,067.32 / $6,679.00
| Facility | | $505.78 | $1,067.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,862.57 / $5,738.27 / $10,228.16
| Professional | | $4,862.57 | $5,738.27 | $10,228.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,647.74 / $12,006.91 / $13,467.61
| Facility | | $8,647.74 | $12,006.91 | $13,467.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $403.89 / $828.24 / $7,198.43
| Professional | | $403.89 | $828.24 | $7,198.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $7,143.30
| Facility | | $55.00 | $55.00 | $7,143.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.87 / $245.87 / $245.87
| Facility | AS | $245.87 | $245.87 | $245.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,758.78 / $11,887.35 / $28,088.65
| Professional | | $6,758.78 | $11,887.35 | $28,088.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,181.42 / $9,174.44 / $17,759.15
| Professional | | $6,181.42 | $9,174.44 | $17,759.15 |