- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.39 / $2,747.00 / $4,806.64
| Facility | | $580.39 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.10 / $595.76 / $838.29
| Professional | | $512.10 | $595.76 | $838.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $322.00 / $1,640.00 / $5,559.68
| Facility | | $322.00 | $1,640.00 | $5,559.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $599.52 / $1,166.09 / $4,646.20
| Professional | | $599.52 | $1,166.09 | $4,646.20 |
- 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
- $569.23 / $1,006.96 / $2,134.38
| Professional | | $569.23 | $1,006.96 | $2,134.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $981.32 / $6,679.00
| Facility | | $300.00 | $981.32 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $695.12 / $883.18 / $1,290.29
| Professional | | $695.12 | $883.18 | $1,290.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.40 / $1,499.06 / $1,858.18
| Professional | | $759.40 | $1,499.06 | $1,858.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,376.00 / $5,559.68
| Facility | | $55.00 | $2,376.00 | $5,559.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.29 / $1,190.77 / $4,646.20
| Professional | | $632.29 | $1,190.77 | $4,646.20 |
- 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
- $618.66 / $861.66 / $2,155.19
| Professional | | $618.66 | $861.66 | $2,155.19 |