- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $657.00 / $2,747.00 / $8,017.00
| Facility | | $657.00 | $2,747.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.20 / $123.13 / $197.27
| Professional | | $107.20 | $123.13 | $197.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.25 / $135.16 / $257.87
| Professional | | $130.25 | $135.16 | $257.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.06 / $173.97 / $267.36
| Professional | | $128.06 | $173.97 | $267.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.94 / $204.74 / $204.74
| Professional | | $153.94 | $204.74 | $204.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,676.03 / $3,676.03 / $3,676.03
| Facility | | $3,676.03 | $3,676.03 | $3,676.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $918.00 / $3,077.00 / $8,017.00
| Facility | | $918.00 | $3,077.00 | $8,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.35 / $139.33 / $700.00
| Professional | | $115.35 | $139.33 | $700.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $161.80 / $327.30
| Professional | | $3.00 | $161.80 | $327.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.16 / $179.13 / $299.83
| Professional | | $135.16 | $179.13 | $299.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.86 / $126.86 / $133.01
| Facility | | $126.86 | $126.86 | $133.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.52 / $127.96 / $133.04
| Professional | | $122.52 | $127.96 | $133.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.42 / $163.09 / $265.14
| Professional | | $126.42 | $163.09 | $265.14 |