- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $658.46 / $5,360.00 / $9,975.00
| Facility | | $658.46 | $5,360.00 | $9,975.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.73 / $658.46 / $764.34
| Professional | | $567.73 | $658.46 | $764.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,525.00 / $11,065.00 / $12,418.00
| Facility | | $8,525.00 | $11,065.00 | $12,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $554.10 / $708.58 / $971.81
| Professional | | $554.10 | $708.58 | $971.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $689.95 / $993.53 / $7,369.00
| Professional | | $689.95 | $993.53 | $7,369.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.25 / $778.18 / $1,450.92
| Professional | | $587.25 | $778.18 | $1,450.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.12 / $685.34 / $845.26
| Professional | | $571.12 | $685.34 | $845.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.91 / $786.94 / $1,121.98
| Facility | | $613.91 | $786.94 | $1,121.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $735.00 / $828.00 / $1,406.64
| Professional | | $735.00 | $828.00 | $1,406.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $585.57 / $768.79 / $7,902.00
| Facility | | $585.57 | $768.79 | $7,902.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.57 / $768.79 / $7,902.00
| Professional | | $585.57 | $768.79 | $7,902.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.00 / $13,296.00 / $26,537.00
| Facility | | $8,367.00 | $13,296.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.03 / $769.36 / $1,282.68
| Professional | | $471.03 | $769.36 | $1,282.68 |