- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $496.67 / $5,360.00 / $9,975.00
| Facility | | $496.67 | $5,360.00 | $9,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.50 / $487.83 / $722.27
| Professional | | $433.50 | $487.83 | $722.27 |
- 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
- $397.99 / $508.94 / $698.01
| Professional | | $397.99 | $508.94 | $698.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $479.63 / $691.52 / $4,284.00
| Professional | | $479.63 | $691.52 | $4,284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.25 / $576.53 / $1,069.05
| Professional | | $438.25 | $576.53 | $1,069.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $412.55 / $495.06 / $610.57
| Professional | | $412.55 | $495.06 | $610.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $482.00 / $599.14 / $892.73
| Facility | | $482.00 | $599.14 | $892.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.00 / $601.00 / $1,012.27
| Professional | | $541.00 | $601.00 | $1,012.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $425.79 / $571.67 / $5,122.00
| Facility | | $425.79 | $571.67 | $5,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.79 / $571.67 / $5,122.00
| Professional | | $425.79 | $571.67 | $5,122.00 |
- 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
- $373.18 / $585.29 / $945.08
| Professional | | $373.18 | $585.29 | $945.08 |