- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.71 / $2,747.00 / $4,806.64
| Facility | | $527.71 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.69 / $550.16 / $809.08
| Professional | | $454.69 | $550.16 | $809.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,777.97 / $3,812.34
| Facility | | $55.00 | $1,777.97 | $3,812.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.50 / $1,065.73 / $3,977.36
| Professional | | $535.50 | $1,065.73 | $3,977.36 |
- 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
- $471.89 / $919.45 / $1,946.88
| Professional | | $471.89 | $919.45 | $1,946.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $898.46 / $6,679.00
| Facility | | $300.00 | $898.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.90 / $808.61 / $1,167.99
| Professional | | $635.90 | $808.61 | $1,167.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.27 / $1,359.38 / $1,747.48
| Professional | | $694.27 | $1,359.38 | $1,747.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $3,812.34
| Facility | | $55.00 | $2,446.00 | $3,812.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $577.07 / $1,087.27 / $3,977.36
| Professional | | $577.07 | $1,087.27 | $3,977.36 |
- 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
- $538.63 / $778.11 / $1,890.00
| Professional | | $538.63 | $778.11 | $1,890.00 |