- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.30 / $2,747.00 / $4,806.64
| Facility | | $487.30 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $461.76 / $565.13 / $798.86
| Professional | | $461.76 | $565.13 | $798.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,841.85 / $3,937.98
| Facility | | $55.00 | $1,841.85 | $3,937.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $531.50 / $1,086.04 / $4,108.00
| Professional | | $531.50 | $1,086.04 | $4,108.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.91 / $611.91 / $688.76
| Professional | | $611.91 | $611.91 | $688.76 |
- 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
- $469.60 / $941.30 / $2,010.93
| Professional | | $469.60 | $941.30 | $2,010.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $931.98 / $6,679.00
| Facility | | $300.00 | $931.98 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.97 / $838.78 / $1,211.57
| Professional | | $657.97 | $838.78 | $1,211.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $716.39 / $1,402.69 / $1,803.15
| Professional | | $716.39 | $1,402.69 | $1,803.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $3,937.98
| Facility | | $55.00 | $2,446.00 | $3,937.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $578.22 / $1,112.79 / $4,108.00
| Professional | | $578.22 | $1,112.79 | $4,108.00 |
- 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
- $549.60 / $873.26 / $2,187.53
| Professional | | $549.60 | $873.26 | $2,187.53 |