- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $623.22 / $2,747.00 / $4,806.64
| Facility | | $623.22 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.45 / $651.72 / $919.35
| Professional | | $564.45 | $651.72 | $919.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,845.00 / $5,115.53
| Facility | | $55.00 | $1,845.00 | $5,115.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.94 / $1,227.51 / $4,637.76
| Professional | | $660.94 | $1,227.51 | $4,637.76 |
- 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
- $581.26 / $1,047.22 / $2,245.48
| Professional | | $581.26 | $1,047.22 | $2,245.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,026.66 / $6,679.00
| Facility | | $300.00 | $1,026.66 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.83 / $923.99 / $1,354.72
| Professional | | $729.83 | $923.99 | $1,354.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $789.71 / $1,546.25 / $1,918.14
| Professional | | $789.71 | $1,546.25 | $1,918.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $5,115.53
| Facility | | $55.00 | $2,446.00 | $5,115.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $710.00 / $1,227.51 / $4,637.76
| Professional | | $710.00 | $1,227.51 | $4,637.76 |
- 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
- $664.35 / $963.28 / $2,048.16
| Professional | | $664.35 | $963.28 | $2,048.16 |