- 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 / $458.54 / $680.42
| Professional | | $412.89 | $458.54 | $680.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,006.00 / $13,486.75
| Facility | | $55.00 | $4,006.00 | $13,486.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.64 / $1,309.05 / $3,882.48
| Professional | | $491.64 | $1,309.05 | $3,882.48 |
- 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
- $591.85 / $1,104.58 / $2,168.92
| Professional | | $591.85 | $1,104.58 | $2,168.92 |
- 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
- $775.19 / $775.19 / $911.98
| Professional | | $775.19 | $775.19 | $911.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.23 / $1,585.58 / $2,000.52
| Professional | | $803.23 | $1,585.58 | $2,000.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,825.44 / $13,486.75
| Facility | | $55.00 | $3,825.44 | $13,486.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.64 / $1,195.33 / $3,882.48
| Professional | | $491.64 | $1,195.33 | $3,882.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,006.00 / $10,764.00
| Facility | | $1,591.00 | $4,006.00 | $10,764.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.64 / $988.12 / $2,106.50
| Professional | | $487.64 | $988.12 | $2,106.50 |