- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.57 / $1,885.00 / $3,693.00
| Facility | | $313.57 | $1,885.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $287.95 / $564.39
| Professional | | $177.83 | $287.95 | $564.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.13 / $2,376.00 / $8,498.00
| Facility | | $526.13 | $2,376.00 | $8,498.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.52 / $107.52 / $107.52
| Facility | AS | $107.52 | $107.52 | $107.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.70 / $491.43 / $1,574.88
| Professional | | $234.70 | $491.43 | $1,574.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $253.23 / $329.20 / $580.91
| Facility | | $253.23 | $329.20 | $580.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.88 / $437.38 / $916.69
| Professional | | $245.88 | $437.38 | $916.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.05 / $461.74 / $6,679.00
| Facility | | $220.05 | $461.74 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.44 / $474.06 / $654.39
| Professional | | $376.44 | $474.06 | $654.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $270.33 / $572.30 / $963.85
| Professional | | $270.33 | $572.30 | $963.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,189.88 / $1,189.88 / $3,217.80
| Facility | | $1,189.88 | $1,189.88 | $3,217.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,075.21 / $3,372.00 / $16,394.00
| Facility | | $1,075.21 | $3,372.00 | $16,394.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $107.52 / $107.52 / $107.52
| Facility | AS | $107.52 | $107.52 | $107.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.42 / $632.58 / $2,443.28
| Professional | | $362.42 | $632.58 | $2,443.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.00 / $3,372.00 / $8,425.00
| Facility | | $1,640.00 | $3,372.00 | $8,425.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $322.02 / $490.80 / $1,020.04
| Professional | | $322.02 | $490.80 | $1,020.04 |