- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.16 / $2,747.00 / $4,806.64
| Facility | | $458.16 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.30 / $465.18 / $683.41
| Professional | | $416.30 | $465.18 | $683.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,467.95 / $3,729.00
| Facility | | $55.00 | $1,467.95 | $3,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.36 / $880.67 / $3,304.00
| Professional | | $467.36 | $880.67 | $3,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.00 / $732.56 / $1,425.63
| Professional | | $430.00 | $732.56 | $1,425.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.02 / $979.18 / $6,679.00
| Facility | | $454.02 | $979.18 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.99 / $660.95 / $1,002.10
| Professional | | $520.99 | $660.95 | $1,002.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.79 / $1,101.94 / $1,401.68
| Professional | | $562.79 | $1,101.94 | $1,401.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.36 / $819.36 / $819.36
| Professional | | $819.36 | $819.36 | $819.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $3,729.00
| Facility | | $55.00 | $2,446.00 | $3,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.47 / $883.89 / $3,304.00
| Professional | | $508.47 | $883.89 | $3,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,446.00 / $4,050.00
| Facility | | $789.00 | $2,446.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $474.57 / $718.38 / $1,664.03
| Professional | | $474.57 | $718.38 | $1,664.03 |