- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $595.54 / $2,747.00 / $8,017.00
| Facility | | $595.54 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.21 / $432.45 / $887.95
| Professional | | $163.21 | $432.45 | $887.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,639.91 / $11,851.00 / $28,970.26
| Facility | | $8,639.91 | $11,851.00 | $28,970.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.45 / $441.70 / $458.37
| Professional | | $375.45 | $441.70 | $458.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.03 / $358.03 / $1,069.47
| Professional | | $178.03 | $358.03 | $1,069.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.16 / $716.16 / $729.23
| Professional | | $716.16 | $716.16 | $729.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.49 / $172.49 / $178.11
| Professional | | $172.49 | $172.49 | $178.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $3,389.00 / $8,017.00
| Facility | | $832.00 | $3,389.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.56 / $434.51 / $1,125.58
| Professional | | $169.56 | $434.51 | $1,125.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.48 / $1,221.70 / $1,724.10
| Professional | | $218.48 | $1,221.70 | $1,724.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.11 / $383.88 / $1,069.47
| Professional | | $182.11 | $383.88 | $1,069.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.03 / $200.17 / $1,078.45
| Facility | | $157.03 | $200.17 | $1,078.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.03 / $200.17 / $491.95
| Professional | | $157.03 | $200.17 | $491.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.00 / $650.00 / $3,742.00
| Facility | | $144.00 | $650.00 | $3,742.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $542.66 / $815.24 / $1,239.25
| Professional | | $542.66 | $815.24 | $1,239.25 |