- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $743.27 / $2,747.00 / $4,806.64
| Facility | | $743.27 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $664.38 / $781.65 / $1,142.57
| Professional | | $664.38 | $781.65 | $1,142.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,919.06 / $6,209.56
| Facility | | $55.00 | $1,919.06 | $6,209.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $729.00 / $1,493.00 / $5,555.92
| Professional | | $729.00 | $1,493.00 | $5,555.92 |
- 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
- $611.28 / $1,285.83 / $2,717.52
| Professional | | $611.28 | $1,285.83 | $2,717.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,237.20 / $6,679.00
| Facility | | $300.00 | $1,237.20 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.92 / $1,115.67 / $1,638.89
| Professional | | $882.92 | $1,115.67 | $1,638.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.39 / $1,903.94 / $2,352.58
| Professional | | $972.39 | $1,903.94 | $2,352.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $6,209.56
| Facility | | $55.00 | $2,446.00 | $6,209.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.56 / $1,544.75 / $5,555.92
| Professional | | $820.56 | $1,544.75 | $5,555.92 |
- 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
- $740.55 / $1,116.79 / $2,442.36
| Professional | | $740.55 | $1,116.79 | $2,442.36 |