- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.16 / $2,747.00 / $4,806.64
| Facility | | $814.16 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $713.08 / $845.45 / $1,248.91
| Professional | | $713.08 | $845.45 | $1,248.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,078.00 / $7,708.88
| Facility | | $55.00 | $2,078.00 | $7,708.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $824.21 / $1,604.68 / $6,035.68
| Professional | | $824.21 | $1,604.68 | $6,035.68 |
- 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
- $688.79 / $1,393.97 / $2,945.01
| Professional | | $688.79 | $1,393.97 | $2,945.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,343.27 / $6,679.00
| Facility | | $300.00 | $1,343.27 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.91 / $1,211.69 / $1,779.93
| Professional | | $958.91 | $1,211.69 | $1,779.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.35 / $2,085.25 / $2,630.97
| Professional | | $1,056.35 | $2,085.25 | $2,630.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $7,708.88
| Facility | | $55.00 | $2,446.00 | $7,708.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $881.13 / $1,644.94 / $6,035.68
| Professional | | $881.13 | $1,644.94 | $6,035.68 |
- 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
- $853.53 / $1,196.56 / $2,831.79
| Professional | | $853.53 | $1,196.56 | $2,831.79 |