- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $3,311.31 / $10,000.00
| Facility | | $660.69 | $3,311.31 | $10,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $389.05 / $851.14
| Professional | | $309.03 | $389.05 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $331.13 / $676.08
| Professional | | $251.19 | $331.13 | $676.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.59 / $912.01 / $1,659.59
| Facility | | $323.59 | $912.01 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- 62
- Low / Median / High Price
- $398.11 / $398.11 / $398.11
| Facility | 62 | $398.11 | $398.11 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- AS
- Low / Median / High Price
- $63.10 / $63.10 / $63.10
| Facility | AS | $63.10 | $63.10 | $63.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $467.74 / $758.58
| Professional | | $295.12 | $467.74 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,888.44 / $11,481.54
| Facility | | $3,235.94 | $5,888.44 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $309.03 / $398.11
| Professional | | $190.55 | $309.03 | $398.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $562.34
| Professional | | $32.36 | $33.11 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $5,623.41 / $9,772.37
| Facility | | $1,698.24 | $5,623.41 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $363.08 / $645.65
| Professional | | $263.03 | $363.08 | $645.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $288.40 / $407.38
| Professional | | $288.40 | $288.40 | $407.38 |