- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.95 / $5,135.00 / $10,817.74
| Facility | | $1,159.95 | $5,135.00 | $10,817.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.95 / $905.45 / $1,785.12
| Professional | | $773.95 | $905.45 | $1,785.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,134.00 / $7,209.00 / $36,529.00
| Facility | | $2,134.00 | $7,209.00 | $36,529.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $885.40 / $1,178.61 / $1,927.04
| Professional | | $885.40 | $1,178.61 | $1,927.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.78 / $1,048.27 / $1,392.24
| Facility | | $816.78 | $1,048.27 | $1,392.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.92 / $1,222.98 / $127,498.73
| Professional | | $960.92 | $1,222.98 | $127,498.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.24 / $1,282.92 / $1,841.93
| Professional | | $917.24 | $1,282.92 | $1,841.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.67 / $1,042.67 / $1,042.67
| Facility | | $1,042.67 | $1,042.67 | $1,042.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $917.24 / $1,293.27 / $1,874.43
| Professional | | $917.24 | $1,293.27 | $1,874.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.37 / $653.07 / $1,097.26
| Professional | | $72.37 | $653.07 | $1,097.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $763.66 / $1,157.35 / $1,843.42
| Professional | | $763.66 | $1,157.35 | $1,843.42 |