- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,836.00
| Facility | | $969.00 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,021.03 / $1,238.22 / $1,707.79
| Professional | | $1,021.03 | $1,238.22 | $1,707.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,035.75 / $1,311.00 / $1,826.52
| Professional | | $1,035.75 | $1,311.00 | $1,826.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.40 / $1,081.40 / $1,081.40
| Facility | | $1,081.40 | $1,081.40 | $1,081.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,172.82 / $1,507.91 / $2,356.41
| Professional | | $1,172.82 | $1,507.91 | $2,356.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $20,374.88
| Facility | | $55.00 | $55.00 | $20,374.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,987.68 / $8,173.68 / $9,718.95
| Professional | | $7,987.68 | $8,173.68 | $9,718.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.21 / $1,403.27 / $2,511.37
| Facility | | $1,093.21 | $1,403.27 | $2,511.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.89 / $1,685.63 / $1,983.10
| Professional | | $1,211.89 | $1,685.63 | $1,983.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,459.20 / $1,459.20 / $1,459.20
| Professional | | $1,459.20 | $1,459.20 | $1,459.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,093.21 / $1,406.41 / $2,833.02
| Facility | | $1,093.21 | $1,406.41 | $2,833.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.52 / $1,554.08 / $2,447.54
| Professional | | $1,174.52 | $1,554.08 | $2,447.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $2,546.00 / $9,000.00
| Facility | | $495.00 | $2,546.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.54 / $1,265.88 / $2,011.75
| Professional | | $931.54 | $1,265.88 | $2,011.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $940.28 / $1,072.74 / $1,475.12
| Professional | | $940.28 | $1,072.74 | $1,475.12 |