- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $709.80 / $5,087.00 / $8,925.00
| Facility | | $709.80 | $5,087.00 | $8,925.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.48 / $705.09 / $995.64
| Professional | | $573.48 | $705.09 | $995.64 |
- 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
- $516.35 / $657.41 / $916.29
| Professional | | $516.35 | $657.41 | $916.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $652.03 / $898.41 / $4,284.00
| Professional | | $652.03 | $898.41 | $4,284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.70 / $806.46 / $1,298.48
| Professional | | $571.70 | $806.46 | $1,298.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.33 / $635.20 / $783.41
| Professional | | $529.33 | $635.20 | $783.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $665.61 / $835.58 / $1,243.32
| Facility | | $665.61 | $835.58 | $1,243.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.00 / $875.76 / $1,302.85
| Professional | | $773.00 | $875.76 | $1,302.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.66 / $834.81 / $7,420.00
| Facility | | $593.66 | $834.81 | $7,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.66 / $834.81 / $7,420.00
| Professional | | $593.66 | $834.81 | $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
- $551.87 / $865.71 / $1,356.20
| Professional | | $551.87 | $865.71 | $1,356.20 |