- 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
- $1,105.26 / $1,337.73 / $1,845.87
| Professional | | $1,105.26 | $1,337.73 | $1,845.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,115.47 / $1,412.27 / $1,967.11
| Professional | | $1,115.47 | $1,412.27 | $1,967.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.83 / $1,140.83 / $1,140.83
| Facility | | $1,140.83 | $1,140.83 | $1,140.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.04 / $1,636.19 / $2,530.46
| Professional | | $1,260.04 | $1,636.19 | $2,530.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $21,827.52
| Facility | | $55.00 | $55.00 | $21,827.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,559.04 / $8,766.48 / $10,437.83
| Professional | | $8,559.04 | $8,766.48 | $10,437.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,167.30 / $1,499.77 / $2,726.07
| Facility | | $1,167.30 | $1,499.77 | $2,726.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.49 / $1,808.86 / $2,128.07
| Professional | | $1,300.49 | $1,808.86 | $2,128.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,305.80 / $1,638.34 / $2,059.12
| Professional | | $1,305.80 | $1,638.34 | $2,059.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,154.42 / $1,522.52 / $3,070.58
| Facility | | $1,154.42 | $1,522.52 | $3,070.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,262.68 / $1,682.60 / $2,705.27
| Professional | | $1,262.68 | $1,682.60 | $2,705.27 |
- 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
- $1,027.54 / $1,411.20 / $2,157.26
| Professional | | $1,027.54 | $1,411.20 | $2,157.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.02 / $1,153.67 / $1,581.08
| Professional | | $1,009.02 | $1,153.67 | $1,581.08 |