- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $411.34 / $2,663.12 / $4,410.00
| Facility | | $411.34 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.40 / $411.34 / $609.76
| Professional | | $368.40 | $411.34 | $609.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $874.12 / $4,705.13 / $26,542.00
| Facility | | $874.12 | $4,705.13 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.19 / $739.94 / $2,845.22
| Professional | | $385.19 | $739.94 | $2,845.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $1,947.00 / $14,611.50
| Facility | | $1,770.00 | $1,947.00 | $14,611.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.74 / $642.11 / $1,265.73
| Professional | | $363.74 | $642.11 | $1,265.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.86 / $1,800.00 / $8,208.00
| Facility | | $359.86 | $1,800.00 | $8,208.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.94 / $521.79 / $932.94
| Professional | | $412.94 | $521.79 | $932.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.66 / $897.50 / $1,132.38
| Professional | | $454.66 | $897.50 | $1,132.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $6,883.00 / $37,231.85
| Facility | | $1,697.00 | $6,883.00 | $37,231.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.79 / $769.55 / $2,845.22
| Professional | | $416.79 | $769.55 | $2,845.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,697.00 / $4,671.00 / $13,017.00
| Facility | | $1,697.00 | $4,671.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.97 / $644.37 / $1,365.43
| Professional | | $411.97 | $644.37 | $1,365.43 |