- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.67 / $2,747.00 / $4,806.64
| Facility | | $658.67 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $622.23 / $710.41 / $1,823.85
| Professional | | $622.23 | $710.41 | $1,823.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,845.00 / $6,466.88
| Facility | | $55.00 | $1,845.00 | $6,466.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.58 / $1,317.53 / $5,061.76
| Professional | | $696.58 | $1,317.53 | $5,061.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.11 / $1,353.66 / $1,833.74
| Professional | | $983.11 | $1,353.66 | $1,833.74 |
- 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
- $598.85 / $1,140.11 / $2,390.09
| Professional | | $598.85 | $1,140.11 | $2,390.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $1,505.12 / $6,679.00
| Facility | | $506.00 | $1,505.12 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.96 / $1,017.16 / $1,494.17
| Professional | | $804.96 | $1,017.16 | $1,494.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.96 / $1,748.88 / $2,206.57
| Professional | | $885.96 | $1,748.88 | $2,206.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $6,466.88
| Facility | | $55.00 | $2,446.00 | $6,466.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $744.20 / $1,349.22 / $5,061.76
| Professional | | $744.20 | $1,349.22 | $5,061.76 |
- 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
- $719.27 / $1,044.54 / $2,510.71
| Professional | | $719.27 | $1,044.54 | $2,510.71 |