- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $468.52 / $2,747.00 / $4,806.64
| Facility | | $468.52 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.89 / $498.12 / $702.49
| Professional | | $434.89 | $498.12 | $702.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $494.00 / $2,851.02 / $7,929.30
| Facility | | $494.00 | $2,851.02 | $7,929.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.04 / $886.99 / $3,627.28
| Professional | | $520.04 | $886.99 | $3,627.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $680.00 / $1,915.00 / $3,111.82
| Facility | | $680.00 | $1,915.00 | $3,111.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.20 / $842.50 / $1,773.79
| Professional | | $448.20 | $842.50 | $1,773.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.00 / $1,099.42 / $6,679.00
| Facility | | $377.00 | $1,099.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $581.48 / $742.11 / $1,079.35
| Professional | | $581.48 | $742.11 | $1,079.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $632.41 / $1,248.40 / $1,653.84
| Professional | | $632.41 | $1,248.40 | $1,653.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $399.12 / $399.12 / $399.12
| Professional | | $399.12 | $399.12 | $399.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,006.00 / $7,929.30
| Facility | | $55.00 | $3,006.00 | $7,929.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.32 / $927.23 / $3,627.28
| Professional | | $548.32 | $927.23 | $3,627.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $4,402.00 / $9,212.00
| Facility | | $1,485.00 | $4,402.00 | $9,212.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.01 / $770.61 / $1,852.77
| Professional | | $535.01 | $770.61 | $1,852.77 |