- 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
- $1,488.02 / $1,693.51 / $2,034.77
| Professional | | $1,488.02 | $1,693.51 | $2,034.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,386.33 / $1,754.76 / $2,444.77
| Professional | | $1,386.33 | $1,754.76 | $2,444.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.40 / $1,407.40 / $1,407.40
| Facility | | $1,407.40 | $1,407.40 | $1,407.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.19 / $2,116.35 / $3,191.87
| Professional | | $1,569.19 | $2,116.35 | $3,191.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $43,982.64
| Facility | | $55.00 | $55.00 | $43,982.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,063.00 / $14,063.00 / $14,063.00
| Professional | | $14,063.00 | $14,063.00 | $14,063.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,569.19 / $1,985.00 / $3,400.69
| Facility | | $1,569.19 | $1,985.00 | $3,400.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,906.98 / $2,200.37 / $2,567.09
| Professional | | $1,906.98 | $2,200.37 | $2,567.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,752.50 / $2,752.50 / $2,752.50
| Professional | | $2,752.50 | $2,752.50 | $2,752.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,569.19 / $1,993.36 / $3,864.88
| Facility | | $1,569.19 | $1,993.36 | $3,864.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.19 / $2,151.21 / $3,258.20
| Professional | | $1,569.19 | $2,151.21 | $3,258.20 |
- 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
- $1,281.61 / $1,762.22 / $2,723.43
| Professional | | $1,281.61 | $1,762.22 | $2,723.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.96 / $1,432.63 / $1,960.89
| Professional | | $1,251.96 | $1,432.63 | $1,960.89 |