- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.00 / $4,392.00 / $9,661.00
| Facility | | $1,548.00 | $4,392.00 | $9,661.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.48 / $358.06 / $445.57
| Professional | | $251.48 | $358.06 | $445.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,248.00 / $5,196.00 / $11,909.00
| Facility | | $3,248.00 | $5,196.00 | $11,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.00 / $104.70 / $174.03
| Professional | | $89.00 | $104.70 | $174.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.74 / $417.74 / $417.74
| Facility | | $417.74 | $417.74 | $417.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,646.42 / $1,646.42 / $1,646.42
| Professional | | $1,646.42 | $1,646.42 | $1,646.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.73 / $524.73 / $524.73
| Professional | | $524.73 | $524.73 | $524.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.77 / $324.77 / $324.77
| Facility | | $324.77 | $324.77 | $324.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.77 / $487.22 / $776.61
| Professional | | $324.77 | $487.22 | $776.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,989.16 / $8,989.16 / $12,646.78
| Facility | | $8,989.16 | $8,989.16 | $12,646.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.74 / $555.00 / $597.00
| Facility | | $417.74 | $555.00 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,646.42 / $1,646.42 / $1,646.42
| Professional | | $1,646.42 | $1,646.42 | $1,646.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,264.00 / $5,248.00 / $11,200.00
| Facility | | $2,264.00 | $5,248.00 | $11,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.94 / $458.74 / $1,077.71
| Professional | | $323.94 | $458.74 | $1,077.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $324.77 / $334.43 / $334.43
| Facility | | $324.77 | $334.43 | $334.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.43 / $334.43 / $776.61
| Professional | | $334.43 | $334.43 | $776.61 |