- 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
- $1,565.39 / $1,791.23 / $2,139.96
| Professional | | $1,565.39 | $1,791.23 | $2,139.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,452.82 / $1,838.91 / $2,562.02
| Professional | | $1,452.82 | $1,838.91 | $2,562.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.98 / $1,500.98 / $1,500.98
| Facility | | $1,500.98 | $1,500.98 | $1,500.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,640.37 / $2,151.71 / $3,386.37
| Professional | | $1,640.37 | $2,151.71 | $3,386.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $37,334.01
| Facility | | $55.00 | $55.00 | $37,334.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,371.15 / $11,434.40 / $13,532.85
| Professional | | $11,371.15 | $11,434.40 | $13,532.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.37 / $2,040.36 / $3,590.94
| Facility | | $1,640.37 | $2,040.36 | $3,590.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,999.92 / $2,307.60 / $2,692.20
| Professional | | $1,999.92 | $2,307.60 | $2,692.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,493.21 / $1,640.37 / $2,664.56
| Professional | | $1,493.21 | $1,640.37 | $2,664.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,640.37 / $2,048.04 / $4,050.23
| Facility | | $1,640.37 | $2,048.04 | $4,050.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,640.37 / $2,209.46 / $3,643.78
| Professional | | $1,640.37 | $2,209.46 | $3,643.78 |
- 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
- $1,351.98 / $1,804.34 / $2,838.50
| Professional | | $1,351.98 | $1,804.34 | $2,838.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,312.98 / $1,502.88 / $2,058.79
| Professional | | $1,312.98 | $1,502.88 | $2,058.79 |