- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.79 / $1,533.59 / $14,516.00
| Facility | | $987.79 | $1,533.59 | $14,516.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.63 / $1,039.45 / $3,045.00
| Professional | | $924.63 | $1,039.45 | $3,045.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.08 / $1,838.06 / $2,414.54
| Professional | | $1,017.08 | $1,838.06 | $2,414.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $28,053.00 / $28,053.00 / $28,053.00
| Facility | | $28,053.00 | $28,053.00 | $28,053.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.47 / $1,520.70 / $2,686.18
| Professional | | $881.47 | $1,520.70 | $2,686.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.27 / $1,052.25 / $2,376.30
| Facility | | $949.27 | $1,052.25 | $2,376.30 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.90 / $147.32 / $364.77
| Facility | AS | $132.90 | $147.32 | $364.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,052.25 / $1,052.25 / $2,686.61
| Professional | | $1,052.25 | $1,052.25 | $2,686.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $981.80 / $2,567.00
| Professional | | $7.00 | $981.80 | $2,567.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,688.00 / $15,545.00 / $22,780.00
| Facility | | $6,688.00 | $15,545.00 | $22,780.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.31 / $1,279.43 / $2,927.32
| Professional | | $865.31 | $1,279.43 | $2,927.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $7,796.80 / $9,255.52
| Facility | | $55.00 | $7,796.80 | $9,255.52 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $219.61 / $498.72 / $498.72
| Facility | AS | $219.61 | $498.72 | $498.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,119.84 / $9,205.87 / $9,205.87
| Professional | | $7,119.84 | $9,205.87 | $9,205.87 |