- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.61 / $4,771.00 / $9,539.00
| Facility | | $723.61 | $4,771.00 | $9,539.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.36 / $723.61 / $1,128.83
| Professional | | $572.36 | $723.61 | $1,128.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,032.00 / $6,548.00 / $7,221.00
| Facility | | $5,032.00 | $6,548.00 | $7,221.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $513.91 / $654.32 / $911.99
| Professional | | $513.91 | $654.32 | $911.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.62 / $892.04 / $3,426.00
| Professional | | $618.62 | $892.04 | $3,426.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.46 / $810.14 / $1,453.62
| Professional | | $573.46 | $810.14 | $1,453.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.39 / $631.66 / $779.06
| Professional | | $526.39 | $631.66 | $779.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.82 / $872.38 / $1,244.76
| Facility | | $683.82 | $872.38 | $1,244.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $768.00 / $863.00 / $1,296.22
| Professional | | $768.00 | $863.00 | $1,296.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $609.99 / $827.66 / $7,420.00
| Facility | | $609.99 | $827.66 | $7,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $609.99 / $827.66 / $7,420.00
| Professional | | $609.99 | $827.66 | $7,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,303.00 / $9,373.00 / $17,192.00
| Facility | | $6,303.00 | $9,373.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $564.83 / $851.35 / $1,260.30
| Professional | | $564.83 | $851.35 | $1,260.30 |