- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $659.38 / $4,390.00 / $8,920.00
| Facility | | $659.38 | $4,390.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.29 / $659.38 / $715.13
| Professional | | $544.29 | $659.38 | $715.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.90 / $671.24 / $920.60
| Professional | | $524.90 | $671.24 | $920.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.10 / $855.09 / $11,515.00
| Professional | | $626.10 | $855.09 | $11,515.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.29 / $784.24 / $1,441.04
| Professional | | $585.29 | $784.24 | $1,441.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.46 / $652.15 / $804.32
| Professional | | $543.46 | $652.15 | $804.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.79 / $803.52 / $1,108.52
| Facility | | $613.79 | $803.52 | $1,108.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $732.00 / $842.00 / $1,334.04
| Professional | | $732.00 | $842.00 | $1,334.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.49 / $784.07 / $1,632.00
| Facility | | $563.49 | $784.07 | $1,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $563.49 / $784.07 / $1,632.00
| Professional | | $563.49 | $784.07 | $1,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.00 / $1,906.00 / $3,765.00
| Facility | | $1,066.00 | $1,906.00 | $3,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.02 / $809.08 / $1,211.27
| Professional | | $483.02 | $809.08 | $1,211.27 |