- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.35 / $2,561.00 / $8,294.00
| Facility | | $519.35 | $2,561.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.91 / $512.21 / $637.77
| Professional | | $441.91 | $512.21 | $637.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,060.00 / $3,693.00 / $4,290.00
| Facility | | $3,060.00 | $3,693.00 | $4,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $417.34 / $533.69 / $731.95
| Professional | | $417.34 | $533.69 | $731.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $502.08 / $724.42 / $3,026.00
| Professional | | $502.08 | $724.42 | $3,026.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.46 / $608.72 / $1,124.18
| Professional | | $456.46 | $608.72 | $1,124.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.15 / $518.58 / $639.58
| Professional | | $432.15 | $518.58 | $639.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.75 / $629.07 / $921.50
| Facility | | $506.75 | $629.07 | $921.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.00 / $646.00 / $1,061.28
| Professional | | $568.00 | $646.00 | $1,061.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $466.04 / $607.92 / $3,512.00
| Facility | | $466.04 | $607.92 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.04 / $607.92 / $3,512.00
| Professional | | $466.04 | $607.92 | $3,512.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,349.00 / $7,061.00 / $12,739.00
| Facility | | $4,349.00 | $7,061.00 | $12,739.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.48 / $636.88 / $983.77
| Professional | | $396.48 | $636.88 | $983.77 |