- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $613.35 / $2,561.00 / $8,294.00
| Facility | | $613.35 | $2,561.00 | $8,294.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.75 / $605.34 / $676.31
| Professional | | $522.75 | $605.34 | $676.31 |
- 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
- $509.85 / $651.99 / $894.20
| Professional | | $509.85 | $651.99 | $894.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $600.41 / $890.32 / $3,774.00
| Professional | | $600.41 | $890.32 | $3,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.14 / $715.41 / $1,328.42
| Professional | | $532.14 | $715.41 | $1,328.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $519.16 / $622.99 / $768.36
| Professional | | $519.16 | $622.99 | $768.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.34 / $728.70 / $1,036.56
| Facility | | $605.34 | $728.70 | $1,036.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.71 / $769.00 / $1,296.79
| Professional | | $660.71 | $769.00 | $1,296.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.62 / $716.43 / $6,585.00
| Facility | | $524.62 | $716.43 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.62 / $716.43 / $6,585.00
| Professional | | $524.62 | $716.43 | $6,585.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,693.00 / $11,671.00 / $21,639.00
| Facility | | $6,693.00 | $11,671.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.95 / $711.04 / $1,163.01
| Professional | | $440.95 | $711.04 | $1,163.01 |