- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,398.60 / $1,398.60 / $23,876.00
| Facility | | $1,398.60 | $1,398.60 | $23,876.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,231.67 / $1,756.36 / $4,251.00
| Professional | | $1,231.67 | $1,756.36 | $4,251.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.35 / $4,357.33 / $13,017.00
| Facility | | $818.35 | $4,357.33 | $13,017.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.62 / $331.62 / $667.98
| Facility | AS | $331.62 | $331.62 | $667.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.56 / $2,685.58 / $9,636.95
| Professional | | $1,017.56 | $2,685.58 | $9,636.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,196.57 / $3,196.57 / $3,196.57
| Professional | | $3,196.57 | $3,196.57 | $3,196.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49,922.00 / $52,419.00 / $56,064.00
| Facility | | $49,922.00 | $52,419.00 | $56,064.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,917.08 / $2,811.48 / $5,095.52
| Professional | | $1,917.08 | $2,811.48 | $5,095.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,355.07 / $2,141.01 / $6,679.00
| Facility | | $1,355.07 | $2,141.01 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,554.94 / $1,940.74 / $2,886.30
| Professional | | $1,554.94 | $1,940.74 | $2,886.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,732.20 / $3,433.91 / $4,359.95
| Professional | | $1,732.20 | $3,433.91 | $4,359.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,078.00 / $14,018.00
| Facility | | $55.00 | $6,078.00 | $14,018.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $331.62 / $331.62 / $667.98
| Facility | AS | $331.62 | $331.62 | $667.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,103.08 / $2,920.14 / $9,636.95
| Professional | | $1,103.08 | $2,920.14 | $9,636.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,077.63 / $2,028.59 / $4,569.82
| Professional | | $1,077.63 | $2,028.59 | $4,569.82 |