- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,570.00 / $10,836.00
| Facility | | $969.00 | $3,570.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.68 / $1,485.51 / $1,783.75
| Professional | | $1,300.68 | $1,485.51 | $1,783.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.32 / $1,527.58 / $2,088.03
| Professional | | $1,202.32 | $1,527.58 | $2,088.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,248.38 / $1,248.38 / $1,248.38
| Facility | | $1,248.38 | $1,248.38 | $1,248.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.60 / $1,826.76 / $2,921.71
| Professional | | $1,371.60 | $1,826.76 | $2,921.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $38,591.80
| Facility | | $55.00 | $55.00 | $38,591.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,046.00 / $18,272.75 / $18,272.75
| Professional | | $17,046.00 | $18,272.75 | $18,272.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.60 / $1,731.16 / $3,600.00
| Facility | | $1,371.60 | $1,731.16 | $3,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,671.50 / $1,928.66 / $2,250.10
| Professional | | $1,671.50 | $1,928.66 | $2,250.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.56 / $1,371.60 / $2,226.80
| Professional | | $1,241.56 | $1,371.60 | $2,226.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,371.60 / $1,779.22 / $3,672.82
| Facility | | $1,371.60 | $1,779.22 | $3,672.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.60 / $1,838.62 / $3,034.39
| Professional | | $1,371.60 | $1,838.62 | $3,034.39 |
- 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
- $1,113.29 / $1,461.19 / $2,328.87
| Professional | | $1,113.29 | $1,461.19 | $2,328.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.36 / $1,253.84 / $1,720.05
| Professional | | $1,097.36 | $1,253.84 | $1,720.05 |