- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $7,920.26 / $20,400.00
| Facility | | $1,758.00 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $738.33 / $1,097.82 / $2,698.40
| Professional | | $738.33 | $1,097.82 | $2,698.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.18 / $1,603.16 / $2,351.25
| Professional | | $929.18 | $1,603.16 | $2,351.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,581.00 / $1,866.44 / $2,239.19
| Professional | | $1,581.00 | $1,866.44 | $2,239.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,097.82 / $1,490.13 / $1,906.55
| Facility | | $1,097.82 | $1,490.13 | $1,906.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,239.68 / $1,446.29 / $2,231.42
| Professional | | $1,239.68 | $1,446.29 | $2,231.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.29 / $1,498.79 / $1,715.20
| Facility | | $1,069.29 | $1,498.79 | $1,715.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,125.00 / $1,631.51 / $5,217.00
| Facility | | $1,125.00 | $1,631.51 | $5,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.76 / $1,706.01 / $2,350.85
| Professional | | $1,381.76 | $1,706.01 | $2,350.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,715.78 / $10,171.54 / $12,117.15
| Facility | | $7,715.78 | $10,171.54 | $12,117.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,488.82 / $1,998.08 / $2,685.44
| Professional | | $1,488.82 | $1,998.08 | $2,685.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,835.00 / $26,404.00
| Facility | | $2,155.00 | $12,835.00 | $26,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.56 / $1,637.31 / $2,522.39
| Professional | | $1,125.56 | $1,637.31 | $2,522.39 |