- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $711.70 / $2,747.00 / $4,806.64
| Facility | | $711.70 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $666.30 / $766.97 / $1,100.58
| Professional | | $666.30 | $766.97 | $1,100.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,880.72 / $6,101.20
| Facility | | $55.00 | $1,880.72 | $6,101.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $771.75 / $1,467.29 / $5,458.80
| Professional | | $771.75 | $1,467.29 | $5,458.80 |
- 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
- $653.17 / $1,257.09 / $2,662.83
| Professional | | $653.17 | $1,257.09 | $2,662.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,216.76 / $6,679.00
| Facility | | $300.00 | $1,216.76 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $867.83 / $1,096.60 / $1,610.88
| Professional | | $867.83 | $1,096.60 | $1,610.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $955.19 / $1,869.78 / $2,309.73
| Professional | | $955.19 | $1,869.78 | $2,309.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $6,101.20
| Facility | | $55.00 | $2,446.00 | $6,101.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.99 / $1,514.79 / $5,458.80
| Professional | | $835.99 | $1,514.79 | $5,458.80 |
- 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
- $807.69 / $1,130.60 / $2,398.42
| Professional | | $807.69 | $1,130.60 | $2,398.42 |