- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.52 / $5,087.00 / $10,767.00
| Facility | | $610.52 | $5,087.00 | $10,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $510.24 / $610.52 / $852.63
| Professional | | $510.24 | $610.52 | $852.63 |
- 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
- $482.94 / $613.99 / $857.00
| Professional | | $482.94 | $613.99 | $857.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.54 / $817.56 / $3,426.00
| Professional | | $614.54 | $817.56 | $3,426.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.25 / $721.52 / $1,234.01
| Professional | | $523.25 | $721.52 | $1,234.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $491.13 / $589.36 / $726.87
| Professional | | $491.13 | $589.36 | $726.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.61 / $725.53 / $1,011.83
| Facility | | $599.61 | $725.53 | $1,011.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.00 / $775.00 / $1,222.44
| Professional | | $691.00 | $775.00 | $1,222.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.25 / $725.96 / $2,552.89
| Facility | | $539.25 | $725.96 | $2,552.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.25 / $725.96 / $2,552.89
| Professional | | $539.25 | $725.96 | $2,552.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.00 / $1,893.00 / $3,765.00
| Facility | | $1,066.00 | $1,893.00 | $3,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.91 / $781.34 / $1,189.09
| Professional | | $479.91 | $781.34 | $1,189.09 |