- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $684.86 / $4,032.00 / $8,920.00
| Facility | | $684.86 | $4,032.00 | $8,920.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.91 / $627.52 / $801.97
| Professional | | $538.91 | $627.52 | $801.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.56 / $328.08 / $547.69
| Professional | | $253.56 | $328.08 | $547.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $597.00 / $597.00 / $1,128.33
| Professional | | $597.00 | $597.00 | $1,128.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.24 / $683.24 / $1,700.00
| Facility | | $683.24 | $683.24 | $1,700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.64 / $747.75 / $1,368.95
| Professional | | $559.64 | $747.75 | $1,368.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.51 / $735.37 / $868.81
| Professional | | $574.51 | $735.37 | $868.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $553.19 / $769.74 / $1,091.40
| Facility | | $553.19 | $769.74 | $1,091.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.00 / $836.00 / $1,410.28
| Professional | | $440.00 | $836.00 | $1,410.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $559.96 / $764.10 / $2,847.24
| Facility | | $559.96 | $764.10 | $2,847.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.96 / $764.10 / $2,847.24
| Professional | | $559.96 | $764.10 | $2,847.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,121.00 / $9,270.00 / $17,192.00
| Facility | | $5,121.00 | $9,270.00 | $17,192.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $202.22 / $381.70 / $909.11
| Professional | | $202.22 | $381.70 | $909.11 |