- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.38 / $2,089.19 / $14,516.00
| Facility | | $1,339.38 | $2,089.19 | $14,516.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.53 / $1,339.38 / $4,150.00
| Professional | | $1,140.53 | $1,339.38 | $4,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,017.08 / $2,011.69 / $3,195.53
| Professional | | $1,017.08 | $2,011.69 | $3,195.53 |
- 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 / $2,009.06 / $3,648.86
| Professional | | $881.47 | $2,009.06 | $3,648.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $949.27 / $1,374.25 / $2,652.82
| Facility | | $949.27 | $1,374.25 | $2,652.82 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $132.90 / $192.40 / $494.82
| Facility | AS | $132.90 | $192.40 | $494.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.25 / $1,374.25 / $3,656.91
| Professional | | $1,374.25 | $1,374.25 | $3,656.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $2,440.69 / $3,460.60
| Professional | | $7.00 | $2,440.69 | $3,460.60 |
- 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
- $1,045.59 / $1,589.08 / $3,666.29
| Professional | | $1,045.59 | $1,589.08 | $3,666.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,523.52 / $12,468.40
| Facility | | $55.00 | $10,523.52 | $12,468.40 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $295.16 / $667.98 / $667.98
| Facility | AS | $295.16 | $667.98 | $667.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,636.95 / $12,420.08 / $12,420.08
| Professional | | $9,636.95 | $12,420.08 | $12,420.08 |