- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.88 / $2,747.00 / $4,806.64
| Facility | | $660.88 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.54 / $692.85 / $963.00
| Professional | | $594.54 | $692.85 | $963.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,845.00 / $6,316.72
| Facility | | $55.00 | $1,845.00 | $6,316.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $712.52 / $1,329.07 / $10,112.56
| Professional | | $712.52 | $1,329.07 | $10,112.56 |
- 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
- $626.29 / $1,139.67 / $2,412.17
| Professional | | $626.29 | $1,139.67 | $2,412.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $1,103.69 / $6,679.00
| Facility | | $300.00 | $1,103.69 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $786.58 / $993.93 / $1,460.05
| Professional | | $786.58 | $993.93 | $1,460.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $865.08 / $1,690.70 / $2,088.51
| Professional | | $865.08 | $1,690.70 | $2,088.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $6,316.72
| Facility | | $55.00 | $2,446.00 | $6,316.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $761.04 / $1,362.94 / $10,112.56
| Professional | | $761.04 | $1,362.94 | $10,112.56 |
- 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
- $725.63 / $1,065.33 / $2,262.27
| Professional | | $725.63 | $1,065.33 | $2,262.27 |