- 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
- $1,489.17 / $1,742.33 / $2,097.36
| Professional | | $1,489.17 | $1,742.33 | $2,097.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.27 / $1,796.45 / $2,451.39
| Professional | | $1,419.27 | $1,796.45 | $2,451.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,420.51 / $1,420.51 / $1,420.51
| Facility | | $1,420.51 | $1,420.51 | $1,420.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,558.36 / $2,045.53 / $2,978.76
| Professional | | $1,558.36 | $2,045.53 | $2,978.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $36,189.30
| Facility | | $55.00 | $55.00 | $36,189.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,937.84 / $19,505.99 / $19,505.99
| Professional | | $18,937.84 | $19,505.99 | $19,505.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,460.53 / $1,834.68 / $3,545.85
| Facility | | $1,460.53 | $1,834.68 | $3,545.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,942.30 / $2,241.12 / $2,614.64
| Professional | | $1,942.30 | $2,241.12 | $2,614.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,413.46 / $1,544.26 / $2,565.76
| Professional | | $1,413.46 | $1,544.26 | $2,565.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,460.53 / $1,840.34 / $3,629.48
| Facility | | $1,460.53 | $1,840.34 | $3,629.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.78 / $2,112.71 / $3,306.25
| Professional | | $1,511.78 | $2,112.71 | $3,306.25 |
- 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
- $1,256.73 / $1,675.64 / $2,806.97
| Professional | | $1,256.73 | $1,675.64 | $2,806.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,275.15 / $1,464.12 / $1,996.65
| Professional | | $1,275.15 | $1,464.12 | $1,996.65 |