- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $592.09 / $3,633.00 / $8,920.00
| Facility | | $592.09 | $3,633.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.18 / $592.09 / $737.06
| Professional | | $511.18 | $592.09 | $737.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,766.00 / $6,015.32 / $8,378.12
| Facility | | $3,766.00 | $6,015.32 | $8,378.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.34 / $619.37 / $849.46
| Professional | | $484.34 | $619.37 | $849.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $583.65 / $729.23 / $1,137.58
| Professional | | $583.65 | $729.23 | $1,137.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.74 / $699.74 / $1,298.19
| Professional | | $532.74 | $699.74 | $1,298.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.49 / $601.79 / $742.21
| Professional | | $501.49 | $601.79 | $742.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $580.00 / $726.65 / $1,063.08
| Facility | | $580.00 | $726.65 | $1,063.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.00 / $753.00 / $1,231.75
| Professional | | $677.00 | $753.00 | $1,231.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.09 / $699.64 / $1,632.00
| Facility | | $518.09 | $699.64 | $1,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.09 / $699.64 / $1,632.00
| Professional | | $518.09 | $699.64 | $1,632.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,066.00 / $1,893.00 / $3,765.00
| Facility | | $1,066.00 | $1,893.00 | $3,765.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.10 / $694.85 / $1,147.64
| Professional | | $435.10 | $694.85 | $1,147.64 |