- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $455.06 / $5,087.00 / $8,920.00
| Facility | | $455.06 | $5,087.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.06 / $423.14 / $529.79
| Professional | | $363.06 | $423.14 | $529.79 |
- 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
- $398.90 / $510.11 / $699.61
| Professional | | $398.90 | $510.11 | $699.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $484.09 / $651.89 / $2,413.00
| Professional | | $484.09 | $651.89 | $2,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $408.06 / $543.96 / $1,041.14
| Professional | | $408.06 | $543.96 | $1,041.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $406.41 / $487.69 / $601.49
| Professional | | $406.41 | $487.69 | $601.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.41 / $546.13 / $769.05
| Facility | | $398.41 | $546.13 | $769.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.00 / $567.00 / $974.00
| Professional | | $501.00 | $567.00 | $974.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $413.67 / $541.11 / $3,512.00
| Facility | | $413.67 | $541.11 | $3,512.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.67 / $541.11 / $3,512.00
| Professional | | $413.67 | $541.11 | $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
- $345.59 / $554.95 / $922.33
| Professional | | $345.59 | $554.95 | $922.33 |