- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $943.67 / $2,747.00 / $4,806.64
| Facility | | $943.67 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.35 / $981.18 / $1,460.52
| Professional | | $861.35 | $981.18 | $1,460.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,285.64 / $8,855.52
| Facility | | $55.00 | $2,285.64 | $8,855.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.81 / $1,852.40 / $7,845.00
| Professional | | $974.81 | $1,852.40 | $7,845.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,124.15 / $1,843.49 / $2,497.30
| Professional | | $1,124.15 | $1,843.49 | $2,497.30 |
- 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
- $791.40 / $1,603.11 / $3,403.60
| Professional | | $791.40 | $1,603.11 | $3,403.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $1,909.00 / $6,679.00
| Facility | | $714.00 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.15 / $1,390.17 / $2,042.12
| Professional | | $1,100.15 | $1,390.17 | $2,042.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,207.50 / $2,364.23 / $2,920.53
| Professional | | $1,207.50 | $2,364.23 | $2,920.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $8,855.52
| Facility | | $55.00 | $2,446.00 | $8,855.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,046.32 / $1,926.66 / $7,845.00
| Professional | | $1,046.32 | $1,926.66 | $7,845.00 |
- 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
- $1,015.60 / $1,441.57 / $3,315.15
| Professional | | $1,015.60 | $1,441.57 | $3,315.15 |