- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $33,884.42
| Facility | | $851.14 | $1,047.13 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,174.90 / $2,570.40
| Professional | | $891.25 | $1,174.90 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,479.11
| Professional | | $1,348.96 | $1,348.96 | $1,479.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,174.90 / $1,819.70
| Professional | | $794.33 | $1,174.90 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,148.15 / $1,621.81
| Professional | | $954.99 | $1,148.15 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $25,118.86 / $25,118.86 / $25,118.86
| Facility | | $25,118.86 | $25,118.86 | $25,118.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,348.96 / $2,187.76
| Professional | | $602.56 | $1,348.96 | $2,187.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $1,819.70 / $9,549.93
| Facility | | $54.95 | $1,819.70 | $9,549.93 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $245.47 / $478.63 / $478.63
| Facility | AS | $245.47 | $478.63 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,513.56 / $7,244.36
| Professional | | $954.99 | $1,513.56 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,467.37 / $10,000.00
| Facility | | $2,884.03 | $3,467.37 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $2,344.23
| Professional | | $1,000.00 | $1,412.54 | $2,344.23 |