- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $4,610.00 / $13,151.00
| Facility | | $1,760.00 | $4,610.00 | $13,151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.65 / $276.77 / $1,513.26
| Professional | | $178.65 | $276.77 | $1,513.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $170.22 / $218.51 / $274.12
| Professional | | $170.22 | $218.51 | $274.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,232.00 / $6,557.00 / $13,167.00
| Facility | | $2,232.00 | $6,557.00 | $13,167.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.24 / $308.60 / $476.70
| Professional | | $220.24 | $308.60 | $476.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,710.00 / $17,537.00 / $22,145.00
| Facility | | $10,710.00 | $17,537.00 | $22,145.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.88 / $294.97 / $482.02
| Professional | | $222.88 | $294.97 | $482.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $190.57 / $319.45 / $5,897.00
| Facility | | $190.57 | $319.45 | $5,897.00 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $314.61 / $314.61 / $598.89
| Facility | 62 | $314.61 | $314.61 | $598.89 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $50.34 / $50.34 / $95.82
| Facility | AS | $50.34 | $50.34 | $95.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.23 / $340.07 / $3,668.75
| Professional | | $221.23 | $340.07 | $3,668.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.00 / $1,264.00 / $9,527.00
| Facility | | $245.00 | $1,264.00 | $9,527.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.09 / $317.99 / $482.38
| Professional | | $202.09 | $317.99 | $482.38 |