- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $412.89 / $2,671.00 / $4,806.64
| Facility | | $412.89 | $2,671.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.89 / $491.18 / $726.64
| Professional | | $412.89 | $491.18 | $726.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $6,003.00 / $20,990.91
| Facility | | $55.00 | $6,003.00 | $20,990.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.96 / $1,172.59 / $3,861.88
| Professional | | $490.96 | $1,172.59 | $3,861.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $748.00 / $1,915.00
| Facility | | $50.00 | $748.00 | $1,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.00 / $1,221.56 / $2,316.06
| Professional | | $602.00 | $1,221.56 | $2,316.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,988.12 / $8,090.00
| Facility | | $300.00 | $3,988.12 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.10 / $776.10 / $913.06
| Professional | | $776.10 | $776.10 | $913.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $858.93 / $1,695.53 / $2,139.25
| Professional | | $858.93 | $1,695.53 | $2,139.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,113.54 / $42,640.00
| Facility | | $55.00 | $4,113.54 | $42,640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.61 / $1,149.08 / $3,861.88
| Professional | | $469.61 | $1,149.08 | $3,861.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.00 / $6,003.00 / $13,647.00
| Facility | | $1,804.00 | $6,003.00 | $13,647.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.46 / $949.91 / $2,017.25
| Professional | | $435.46 | $949.91 | $2,017.25 |