- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.14 / $5,087.00 / $8,294.00
| Facility | | $648.14 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.42 / $612.96 / $816.37
| Professional | | $521.42 | $612.96 | $816.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.91 / $696.00 / $1,150.69
| Professional | | $537.91 | $696.00 | $1,150.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $635.41 / $666.47 / $3,019.00
| Professional | | $635.41 | $666.47 | $3,019.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $665.48
| Facility | | $640.00 | $640.00 | $665.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.78 / $708.31 / $1,264.82
| Professional | | $560.78 | $708.31 | $1,264.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.48 / $721.82 / $853.06
| Professional | | $562.48 | $721.82 | $853.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.65 / $752.63 / $1,134.36
| Facility | | $593.65 | $752.63 | $1,134.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $696.68 / $814.00 / $1,131.00
| Professional | | $696.68 | $814.00 | $1,131.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $560.33 / $728.43 / $2,513.28
| Facility | | $560.33 | $728.43 | $2,513.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.33 / $728.43 / $2,513.28
| Professional | | $560.33 | $728.43 | $2,513.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,651.00 / $6,870.00 / $12,739.00
| Facility | | $3,651.00 | $6,870.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.95 / $677.32 / $1,095.16
| Professional | | $444.95 | $677.32 | $1,095.16 |