- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $2,955.00 / $7,625.00
| Facility | | $1,749.00 | $2,955.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,340.40 / $1,539.09 / $2,380.90
| Professional | | $1,340.40 | $1,539.09 | $2,380.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,916.00 / $12,850.00
| Facility | | $1,591.00 | $4,916.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.39 / $2,490.94 / $14,268.77
| Professional | | $1,461.39 | $2,490.94 | $14,268.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,609.57 / $2,678.83 / $4,566.63
| Professional | | $1,609.57 | $2,678.83 | $4,566.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,504.00 / $9,239.00
| Facility | | $83.43 | $3,504.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,132.86 / $2,132.86 / $2,509.25
| Professional | | $2,132.86 | $2,132.86 | $2,509.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,957.89 / $3,881.32 / $5,120.08
| Professional | | $1,957.89 | $3,881.32 | $5,120.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,701.33 / $4,701.33 / $4,701.33
| Facility | | $4,701.33 | $4,701.33 | $4,701.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $459.33 / $502.52 / $1,610.22
| Professional | | $459.33 | $502.52 | $1,610.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,063.00 / $23,514.24
| Facility | | $55.00 | $5,063.00 | $23,514.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,481.66 / $2,476.31 / $14,268.77
| Professional | | $1,481.66 | $2,476.31 | $14,268.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.00 / $6,204.00 / $13,284.00
| Facility | | $2,324.00 | $6,204.00 | $13,284.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.39 / $2,184.92 / $5,075.87
| Professional | | $1,461.39 | $2,184.92 | $5,075.87 |