- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $718.31 / $5,087.00 / $8,294.00
| Facility | | $718.31 | $5,087.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.78 / $562.24 / $718.31
| Professional | | $440.78 | $562.24 | $718.31 |
- 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
- $507.18 / $651.45 / $920.62
| Professional | | $507.18 | $651.45 | $920.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $604.40 / $1,180.83 / $4,284.00
| Professional | | $604.40 | $1,180.83 | $4,284.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.95 / $628.95 / $628.95
| Facility | | $628.95 | $628.95 | $628.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $499.80 / $675.97 / $1,064.96
| Professional | | $499.80 | $675.97 | $1,064.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.83 / $617.45 / $793.66
| Professional | | $524.83 | $617.45 | $793.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.78 / $692.17 / $1,036.00
| Facility | | $519.78 | $692.17 | $1,036.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $683.00 / $781.00 / $1,061.45
| Professional | | $683.00 | $781.00 | $1,061.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $487.25 / $699.72 / $3,440.00
| Facility | | $487.25 | $699.72 | $3,440.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $487.25 / $699.72 / $3,440.00
| Professional | | $487.25 | $699.72 | $3,440.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,911.00 / $3,175.00 / $5,340.00
| Facility | | $1,911.00 | $3,175.00 | $5,340.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.52 / $530.87 / $944.71
| Professional | | $402.52 | $530.87 | $944.71 |