- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.30 / $4,771.00 / $9,539.00
| Facility | | $709.30 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.71 / $626.51 / $753.56
| Professional | | $554.71 | $626.51 | $753.56 |
- 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
- $402.14 / $512.00 / $713.63
| Professional | | $402.14 | $512.00 | $713.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.99 / $623.85 / $1,216.51
| Professional | | $483.99 | $623.85 | $1,216.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.85 / $774.37 / $1,315.66
| Professional | | $447.85 | $774.37 | $1,315.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.87 / $495.44 / $611.04
| Professional | | $412.87 | $495.44 | $611.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.03 / $801.03 / $1,158.74
| Facility | | $553.03 | $801.03 | $1,158.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.00 / $845.00 / $1,337.05
| Professional | | $724.00 | $845.00 | $1,337.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $535.44 / $810.58 / $3,658.00
| Facility | | $535.44 | $810.58 | $3,658.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.44 / $810.58 / $3,658.00
| Professional | | $535.44 | $810.58 | $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
- $547.25 / $884.35 / $1,357.32
| Professional | | $547.25 | $884.35 | $1,357.32 |