- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $639.50 / $2,371.00 / $7,799.00
| Facility | | $639.50 | $2,371.00 | $7,799.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.41 / $631.51 / $897.09
| Professional | | $534.41 | $631.51 | $897.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,928.32 / $5,951.00 / $8,887.00
| Facility | | $3,928.32 | $5,951.00 | $8,887.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.29 / $844.95 / $1,150.26
| Professional | | $529.29 | $844.95 | $1,150.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $579.48 / $791.89 / $1,238.09
| Professional | | $579.48 | $791.89 | $1,238.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.04 / $917.92 / $917.92
| Professional | | $694.04 | $917.92 | $917.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.00 / $2,371.00 / $8,017.00
| Facility | | $641.00 | $2,371.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $534.41 / $653.00 / $1,541.00
| Professional | | $534.41 | $653.00 | $1,541.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $750.10 / $1,476.80
| Professional | | $7.00 | $750.10 | $1,476.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.00 / $798.70 / $1,390.47
| Professional | | $595.00 | $798.70 | $1,390.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.59 / $584.59 / $666.81
| Facility | | $584.59 | $584.59 | $666.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $565.60 / $588.82 / $666.81
| Professional | | $565.60 | $588.82 | $666.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $814.00 / $2,391.00 / $4,789.00
| Facility | | $814.00 | $2,391.00 | $4,789.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.84 / $746.36 / $1,242.58
| Professional | | $591.84 | $746.36 | $1,242.58 |