- 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
- $1,245.65 / $1,422.36 / $1,708.53
| Professional | | $1,245.65 | $1,422.36 | $1,708.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,159.18 / $1,467.23 / $2,044.19
| Professional | | $1,159.18 | $1,467.23 | $2,044.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.04 / $1,196.04 / $1,196.04
| Facility | | $1,196.04 | $1,196.04 | $1,196.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.16 / $1,748.16 / $2,818.37
| Professional | | $1,313.16 | $1,748.16 | $2,818.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $22,748.48
| Facility | | $55.00 | $55.00 | $22,748.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,532.78 / $9,532.78 / $10,869.45
| Professional | | $9,532.78 | $9,532.78 | $10,869.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.16 / $1,643.00 / $2,826.91
| Facility | | $1,313.16 | $1,643.00 | $2,826.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,600.86 / $1,847.15 / $2,155.00
| Professional | | $1,600.86 | $1,847.15 | $2,155.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,190.71 / $1,313.16 / $2,132.69
| Professional | | $1,190.71 | $1,313.16 | $2,132.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.16 / $1,701.36 / $3,232.46
| Facility | | $1,313.16 | $1,701.36 | $3,232.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,313.16 / $1,759.42 / $2,838.88
| Professional | | $1,313.16 | $1,759.42 | $2,838.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $2,547.00 / $9,000.00
| Facility | | $495.00 | $2,547.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.36 / $1,399.24 / $2,261.69
| Professional | | $1,065.36 | $1,399.24 | $2,261.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.99 / $1,200.67 / $1,647.51
| Professional | | $1,050.99 | $1,200.67 | $1,647.51 |