- 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
- $1,551.71 / $1,862.05 / $2,495.69
| Professional | | $1,551.71 | $1,862.05 | $2,495.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,563.01 / $1,978.39 / $2,756.34
| Professional | | $1,563.01 | $1,978.39 | $2,756.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,597.81 / $1,597.81 / $1,597.81
| Facility | | $1,597.81 | $1,597.81 | $1,597.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,578.63 / $2,277.34 / $3,570.24
| Professional | | $1,578.63 | $2,277.34 | $3,570.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $24,847.94
| Facility | | $55.00 | $55.00 | $24,847.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,993.84 / $12,296.88 / $14,621.78
| Professional | | $11,993.84 | $12,296.88 | $14,621.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.17 / $1,946.35 / $3,796.45
| Facility | | $1,419.17 | $1,946.35 | $3,796.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,822.11 / $2,534.38 / $2,981.63
| Professional | | $1,822.11 | $2,534.38 | $2,981.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,568.20 / $1,568.20 / $1,568.20
| Professional | | $1,568.20 | $1,568.20 | $1,568.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.17 / $1,985.68 / $4,206.09
| Facility | | $1,419.17 | $1,985.68 | $4,206.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,688.41 / $2,350.32 / $3,785.57
| Professional | | $1,688.41 | $2,350.32 | $3,785.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.79 / $1,939.84 / $3,073.75
| Professional | | $1,410.79 | $1,939.84 | $3,073.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,413.74 / $1,616.72 / $2,215.17
| Professional | | $1,413.74 | $1,616.72 | $2,215.17 |