- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $712.86 / $4,771.00 / $9,539.00
| Facility | | $712.86 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.61 / $712.86 / $999.84
| Professional | | $587.61 | $712.86 | $999.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $540.35 / $686.98 / $958.88
| Professional | | $540.35 | $686.98 | $958.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $715.34 / $787.87 / $1,536.35
| Professional | | $715.34 | $787.87 | $1,536.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.80 / $808.40 / $1,435.80
| Professional | | $598.80 | $808.40 | $1,435.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $555.48 / $666.58 / $822.11
| Professional | | $555.48 | $666.58 | $822.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $635.02 / $824.88 / $1,204.73
| Facility | | $635.02 | $824.88 | $1,204.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $785.00 / $861.45 / $1,365.46
| Professional | | $785.00 | $861.45 | $1,365.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.82 / $817.39 / $3,658.00
| Facility | | $598.82 | $817.39 | $3,658.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $598.82 / $817.39 / $3,658.00
| Professional | | $598.82 | $817.39 | $3,658.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,547.00 / $3,130.00 / $5,226.00
| Facility | | $1,547.00 | $3,130.00 | $5,226.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.28 / $860.42 / $1,372.30
| Professional | | $553.28 | $860.42 | $1,372.30 |