- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.96 / $3,645.00 / $8,294.00
| Facility | | $545.96 | $3,645.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.85 / $545.96 / $748.70
| Professional | | $425.85 | $545.96 | $748.70 |
- 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
- $460.98 / $589.50 / $808.49
| Professional | | $460.98 | $589.50 | $808.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.60 / $709.21 / $3,426.00
| Professional | | $535.60 | $709.21 | $3,426.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.61 / $640.58 / $1,210.71
| Professional | | $455.61 | $640.58 | $1,210.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.48 / $566.98 / $699.27
| Professional | | $472.48 | $566.98 | $699.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.13 / $645.23 / $922.67
| Facility | | $518.13 | $645.23 | $922.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.00 / $678.00 / $1,157.30
| Professional | | $572.00 | $678.00 | $1,157.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $454.45 / $618.71 / $3,512.00
| Facility | | $454.45 | $618.71 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.48 / $618.71 / $3,512.00
| Professional | | $472.48 | $618.71 | $3,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,349.00 / $7,061.00 / $12,739.00
| Facility | | $4,349.00 | $7,061.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $401.88 / $648.03 / $1,070.32
| Professional | | $401.88 | $648.03 | $1,070.32 |