- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $654.98 / $5,412.00 / $10,767.00
| Facility | | $654.98 | $5,412.00 | $10,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.22 / $623.79 / $766.34
| Professional | | $546.22 | $623.79 | $766.34 |
- 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
- $516.00 / $659.85 / $904.98
| Professional | | $516.00 | $659.85 | $904.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.84 / $824.70 / $5,895.00
| Professional | | $595.84 | $824.70 | $5,895.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.19 / $728.18 / $1,375.51
| Professional | | $536.19 | $728.18 | $1,375.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.60 / $633.12 / $780.85
| Professional | | $527.60 | $633.12 | $780.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.49 / $736.16 / $1,094.50
| Facility | | $614.49 | $736.16 | $1,094.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.00 / $777.00 / $1,292.69
| Professional | | $646.00 | $777.00 | $1,292.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $529.94 / $706.03 / $5,122.00
| Facility | | $529.94 | $706.03 | $5,122.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $529.94 / $706.03 / $5,122.00
| Professional | | $529.94 | $706.03 | $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
- $456.58 / $637.48 / $1,216.01
| Professional | | $456.58 | $637.48 | $1,216.01 |