- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $260.62 / $2,675.00 / $8,113.00
| Facility | | $260.62 | $2,675.00 | $8,113.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.74 / $638.42 / $1,244.00
| Professional | | $179.74 | $638.42 | $1,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,431.95 / $7,827.00 / $19,139.18
| Facility | | $6,431.95 | $7,827.00 | $19,139.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $608.35 / $742.72 / $742.72
| Professional | | $608.35 | $742.72 | $742.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.72 / $693.18 / $1,437.03
| Professional | | $193.72 | $693.18 | $1,437.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $873.59 / $1,158.36 / $1,196.53
| Professional | | $873.59 | $1,158.36 | $1,196.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,434.41 / $7,881.11 / $11,938.27
| Facility | | $2,434.41 | $7,881.11 | $11,938.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.00 / $2,675.00 / $8,017.00
| Facility | | $594.00 | $2,675.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.74 / $640.54 / $1,457.33
| Professional | | $179.74 | $640.54 | $1,457.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $403.30 / $2,186.80
| Professional | | $3.00 | $403.30 | $2,186.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.53 / $693.18 / $1,542.62
| Professional | | $204.53 | $693.18 | $1,542.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.23 / $752.37 / $1,670.12
| Facility | | $196.23 | $752.37 | $1,670.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.23 / $741.47 / $816.27
| Professional | | $196.23 | $741.47 | $816.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $702.46 / $945.28 / $1,581.08
| Professional | | $702.46 | $945.28 | $1,581.08 |