- 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
- $1,300.59 / $1,545.69 / $1,845.54
| Professional | | $1,300.59 | $1,545.69 | $1,845.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,250.31 / $1,593.46 / $2,171.38
| Professional | | $1,250.31 | $1,593.46 | $2,171.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,291.76 / $1,291.76 / $1,291.76
| Facility | | $1,291.76 | $1,291.76 | $1,291.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.63 / $1,861.97 / $2,902.72
| Professional | | $1,425.63 | $1,861.97 | $2,902.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $40,065.48
| Facility | | $55.00 | $55.00 | $40,065.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,341.00 / $19,381.65 / $19,381.65
| Professional | | $15,341.00 | $19,381.65 | $19,381.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.63 / $1,760.41 / $3,078.28
| Facility | | $1,425.63 | $1,760.41 | $3,078.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,735.84 / $2,002.89 / $2,336.71
| Professional | | $1,735.84 | $2,002.89 | $2,336.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,449.40 / $2,449.40 / $2,449.40
| Professional | | $2,449.40 | $2,449.40 | $2,449.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,425.63 / $1,841.20 / $3,509.63
| Facility | | $1,425.63 | $1,841.20 | $3,509.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,425.63 / $1,916.04 / $3,101.89
| Professional | | $1,425.63 | $1,916.04 | $3,101.89 |
- 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
- $1,160.34 / $1,528.21 / $2,427.92
| Professional | | $1,160.34 | $1,528.21 | $2,427.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,139.59 / $1,302.81 / $1,785.85
| Professional | | $1,139.59 | $1,302.81 | $1,785.85 |