- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.36 / $348.36 / $2,525.00
| Facility | | $348.36 | $348.36 | $2,525.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.52 / $363.73 / $715.83
| Professional | | $323.52 | $363.73 | $715.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,695.20 / $52,002.68 / $110,353.20
| Facility | | $1,695.20 | $52,002.68 | $110,353.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.17 / $958.61 / $1,250.83
| Professional | | $592.17 | $958.61 | $1,250.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $808.16 / $1,146.66 / $2,758.44
| Facility | | $808.16 | $1,146.66 | $2,758.44 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $38.33 / $38.33 / $38.33
| Facility | AS | $38.33 | $38.33 | $38.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.16 / $961.69 / $1,428.26
| Professional | | $618.16 | $961.69 | $1,428.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $734.69 / $1,048.32 / $2,172.00
| Facility | | $734.69 | $1,048.32 | $2,172.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.58 / $862.10 / $1,309.79
| Professional | | $546.58 | $862.10 | $1,309.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.02 / $655.64 / $10,451.00
| Facility | | $365.02 | $655.64 | $10,451.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $85.78 / $85.78 / $85.78
| Facility | AS | $85.78 | $85.78 | $85.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.96 / $709.35 / $1,444.61
| Professional | | $392.96 | $709.35 | $1,444.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,891.00 / $12,967.00 / $32,027.00
| Facility | | $5,891.00 | $12,967.00 | $32,027.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.63 / $726.13 / $1,368.67
| Professional | | $389.63 | $726.13 | $1,368.67 |