- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $899.32 / $3,596.00 / $10,836.00
| Facility | | $899.32 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $875.81 / $1,011.53 / $1,209.00
| Professional | | $875.81 | $1,011.53 | $1,209.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.52 / $1,037.42 / $1,430.05
| Professional | | $816.52 | $1,037.42 | $1,430.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $819.04 / $819.04 / $819.04
| Facility | | $819.04 | $819.04 | $819.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $938.10 / $1,227.39 / $1,905.37
| Professional | | $938.10 | $1,227.39 | $1,905.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $11,013.31
| Facility | | $55.00 | $55.00 | $11,013.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,283.76 / $6,442.24 / $7,696.95
| Professional | | $6,283.76 | $6,442.24 | $7,696.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.96 / $1,157.77 / $2,129.35
| Facility | | $913.96 | $1,157.77 | $2,129.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.57 / $1,305.66 / $1,523.27
| Professional | | $1,131.57 | $1,305.66 | $1,523.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,129.50 / $1,129.50 / $1,129.50
| Professional | | $1,129.50 | $1,129.50 | $1,129.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.96 / $1,158.17 / $2,291.98
| Facility | | $913.96 | $1,158.17 | $2,291.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $937.20 / $1,287.45 / $2,211.61
| Professional | | $937.20 | $1,287.45 | $2,211.61 |
- 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
- $770.96 / $1,046.74 / $1,629.52
| Professional | | $770.96 | $1,046.74 | $1,629.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $742.89 / $852.81 / $1,161.47
| Professional | | $742.89 | $852.81 | $1,161.47 |