- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $604.91 / $5,087.00 / $8,294.00
| Facility | | $604.91 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.95 / $552.54 / $795.37
| Professional | | $429.95 | $552.54 | $795.37 |
- 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
- $441.63 / $562.27 / $783.70
| Professional | | $441.63 | $562.27 | $783.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.86 / $680.43 / $6,694.00
| Professional | | $536.86 | $680.43 | $6,694.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.99 / $656.76 / $1,106.59
| Professional | | $485.99 | $656.76 | $1,106.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.94 / $555.53 / $685.15
| Professional | | $462.94 | $555.53 | $685.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.48 / $678.13 / $994.64
| Facility | | $526.48 | $678.13 | $994.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $613.00 / $694.44 / $1,136.10
| Professional | | $613.00 | $694.44 | $1,136.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.66 / $650.10 / $7,420.00
| Facility | | $484.66 | $650.10 | $7,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.66 / $650.10 / $7,420.00
| Professional | | $484.66 | $650.10 | $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
- $425.89 / $692.32 / $1,025.30
| Professional | | $425.89 | $692.32 | $1,025.30 |