- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $491.63 / $2,747.00 / $4,806.64
| Facility | | $491.63 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.63 / $558.59 / $838.03
| Professional | | $491.63 | $558.59 | $838.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,078.00 / $6,324.96
| Facility | | $55.00 | $2,078.00 | $6,324.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.94 / $1,374.00 / $4,970.56
| Professional | | $654.94 | $1,374.00 | $4,970.56 |
- 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
- $602.00 / $1,353.26 / $2,671.08
| Professional | | $602.00 | $1,353.26 | $2,671.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,504.00 / $9,239.00
| Facility | | $83.43 | $3,504.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.80 / $1,011.80 / $1,190.34
| Professional | | $1,011.80 | $1,011.80 | $1,190.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.56 / $1,761.48 / $2,133.83
| Professional | | $928.56 | $1,761.48 | $2,133.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $6,324.96
| Facility | | $55.00 | $2,446.00 | $6,324.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.32 / $1,313.08 / $4,970.56
| Professional | | $653.32 | $1,313.08 | $4,970.56 |
- 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
- $643.97 / $1,181.39 / $2,155.65
| Professional | | $643.97 | $1,181.39 | $2,155.65 |