- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.00 / $2,094.00 / $3,693.00
| Facility | | $988.00 | $2,094.00 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.28 / $149.47 / $337.08
| Professional | | $127.28 | $149.47 | $337.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.08 / $696.49 / $2,733.00
| Facility | | $158.08 | $696.49 | $2,733.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $35.86 / $35.86 / $69.65
| Facility | AS | $35.86 | $35.86 | $69.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.96 / $246.67 / $1,902.24
| Professional | | $142.96 | $246.67 | $1,902.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.66 / $164.66 / $164.66
| Professional | | $164.66 | $164.66 | $164.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.69 / $244.18 / $412.63
| Professional | | $145.69 | $244.18 | $412.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.66 / $300.00 / $8,090.00
| Facility | | $140.66 | $300.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.41 / $195.16 / $264.20
| Professional | | $161.41 | $195.16 | $264.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.36 / $335.58 / $441.73
| Professional | | $177.36 | $335.58 | $441.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,594.40 / $3,727.04 / $19,953.24
| Facility | | $3,594.40 | $3,727.04 | $19,953.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $211.19 / $238.33 / $315.29
| Professional | | $211.19 | $238.33 | $315.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $966.90 / $3,445.00
| Facility | | $55.00 | $966.90 | $3,445.00 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $35.86 / $35.86 / $69.65
| Facility | AS | $35.86 | $35.86 | $69.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.02 / $259.89 / $1,902.24
| Professional | | $153.02 | $259.89 | $1,902.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $627.00 / $1,818.00 / $2,733.00
| Facility | | $627.00 | $1,818.00 | $2,733.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.55 / $219.88 / $406.22
| Professional | | $150.55 | $219.88 | $406.22 |