- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.98 / $2,747.00 / $4,806.64
| Facility | | $576.98 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $557.69 / $663.09 / $881.03
| Professional | | $557.69 | $663.09 | $881.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,845.00 / $4,589.93
| Facility | | $55.00 | $1,845.00 | $4,589.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.03 / $1,261.24 / $4,789.28
| Professional | | $667.03 | $1,261.24 | $4,789.28 |
- 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
- $550.42 / $1,091.40 / $2,344.06
| Professional | | $550.42 | $1,091.40 | $2,344.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,080.58 / $6,679.00
| Facility | | $300.00 | $1,080.58 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $765.28 / $972.53 / $1,420.52
| Professional | | $765.28 | $972.53 | $1,420.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.99 / $1,636.87 / $2,104.19
| Professional | | $835.99 | $1,636.87 | $2,104.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $4,589.93
| Facility | | $55.00 | $2,446.00 | $4,589.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.23 / $1,307.10 / $4,789.28
| Professional | | $709.23 | $1,307.10 | $4,789.28 |
- 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
- $689.46 / $934.74 / $2,270.42
| Professional | | $689.46 | $934.74 | $2,270.42 |