- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $882.00 / $4,264.00 / $8,451.00
| Facility | | $882.00 | $4,264.00 | $8,451.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.25 / $135.38 / $578.00
| Professional | | $113.25 | $135.38 | $578.00 |
- 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
- $132.74 / $137.75 / $213.07
| Professional | | $132.74 | $137.75 | $213.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.66 / $182.85 / $272.24
| Professional | | $141.66 | $182.85 | $272.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.15 / $218.09 / $218.09
| Professional | | $162.15 | $218.09 | $218.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,867.33 / $6,715.99 / $10,722.86
| Facility | | $5,867.33 | $6,715.99 | $10,722.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,894.00 / $9,617.00
| Facility | | $1,020.00 | $4,894.00 | $9,617.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.28 / $166.75 / $676.78
| Professional | | $115.28 | $166.75 | $676.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $203.80 / $328.00
| Professional | | $3.00 | $203.80 | $328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.00 / $182.85 / $306.70
| Professional | | $141.00 | $182.85 | $306.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.73 / $130.08 / $172.12
| Facility | | $121.73 | $130.08 | $172.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.73 / $132.68 / $172.12
| Professional | | $121.73 | $132.68 | $172.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $3,475.00 / $6,000.00
| Facility | | $2,155.00 | $3,475.00 | $6,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.63 / $166.63 / $267.57
| Professional | | $125.63 | $166.63 | $267.57 |