- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.66 / $4,771.00 / $9,539.00
| Facility | | $556.66 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.65 / $556.66 / $784.56
| Professional | | $436.65 | $556.66 | $784.56 |
- 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
- $435.86 / $554.92 / $773.47
| Professional | | $435.86 | $554.92 | $773.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.94 / $646.61 / $1,260.89
| Professional | | $524.94 | $646.61 | $1,260.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.26 / $655.03 / $1,124.28
| Professional | | $485.26 | $655.03 | $1,124.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.23 / $536.67 / $661.90
| Professional | | $447.23 | $536.67 | $661.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $511.29 / $638.73 / $919.38
| Facility | | $511.29 | $638.73 | $919.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $611.00 / $670.00 / $1,218.00
| Professional | | $611.00 | $670.00 | $1,218.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $509.34 / $677.96 / $3,658.00
| Facility | | $509.34 | $677.96 | $3,658.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.34 / $677.96 / $3,658.00
| Professional | | $509.34 | $677.96 | $3,658.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.00 / $3,295.00 / $5,790.00
| Facility | | $1,621.00 | $3,295.00 | $5,790.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.26 / $731.41 / $1,072.13
| Professional | | $432.26 | $731.41 | $1,072.13 |