- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $591.60 / $5,412.00 / $10,767.00
| Facility | | $591.60 | $5,412.00 | $10,767.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.89 / $591.60 / $724.33
| Professional | | $455.89 | $591.60 | $724.33 |
- 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
- $511.38 / $653.95 / $896.89
| Professional | | $511.38 | $653.95 | $896.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $618.70 / $931.09 / $5,895.00
| Professional | | $618.70 | $931.09 | $5,895.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.30 / $729.76 / $1,348.07
| Professional | | $535.30 | $729.76 | $1,348.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.26 / $626.71 / $772.94
| Professional | | $522.26 | $626.71 | $772.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.79 / $727.38 / $1,017.68
| Facility | | $513.79 | $727.38 | $1,017.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $653.00 / $743.00 / $1,293.61
| Professional | | $653.00 | $743.00 | $1,293.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.76 / $746.37 / $3,512.00
| Facility | | $556.76 | $746.37 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $556.76 / $746.37 / $3,512.00
| Professional | | $556.76 | $746.37 | $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
- $447.47 / $783.08 / $1,190.57
| Professional | | $447.47 | $783.08 | $1,190.57 |