- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $909.16 / $2,747.00 / $4,806.64
| Facility | | $909.16 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.68 / $976.22 / $1,380.78
| Professional | | $848.68 | $976.22 | $1,380.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.00 / $2,093.19 / $8,614.00
| Facility | | $322.00 | $2,093.19 | $8,614.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.23 / $1,790.28 / $6,743.92
| Professional | | $930.23 | $1,790.28 | $6,743.92 |
- 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
- $732.94 / $1,560.04 / $3,289.61
| Professional | | $732.94 | $1,560.04 | $3,289.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,811.48 / $6,679.00
| Facility | | $506.00 | $1,811.48 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.99 / $1,354.59 / $1,989.85
| Professional | | $1,071.99 | $1,354.59 | $1,989.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,180.06 / $2,238.57 / $2,851.78
| Professional | | $1,180.06 | $2,238.57 | $2,851.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,376.00 / $8,614.00
| Facility | | $55.00 | $2,376.00 | $8,614.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $997.52 / $1,870.54 / $6,743.92
| Professional | | $997.52 | $1,870.54 | $6,743.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $669.00 / $2,338.00 / $4,952.00
| Facility | | $669.00 | $2,338.00 | $4,952.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.62 / $1,331.20 / $3,222.51
| Professional | | $973.62 | $1,331.20 | $3,222.51 |