- 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
- $1,089.79 / $1,258.38 / $1,504.10
| Professional | | $1,089.79 | $1,258.38 | $1,504.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.51 / $1,294.25 / $1,803.18
| Professional | | $1,022.51 | $1,294.25 | $1,803.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.64 / $1,017.64 / $1,017.64
| Facility | | $1,017.64 | $1,017.64 | $1,017.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,166.76 / $1,559.73 / $2,379.53
| Professional | | $1,166.76 | $1,559.73 | $2,379.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $13,697.20
| Facility | | $55.00 | $55.00 | $13,697.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,338.08 / $8,338.08 / $9,574.43
| Professional | | $8,338.08 | $8,338.08 | $9,574.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.23 / $1,527.52 / $2,723.38
| Facility | | $1,163.23 | $1,527.52 | $2,723.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,407.43 / $1,623.96 / $1,894.62
| Professional | | $1,407.43 | $1,623.96 | $1,894.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,758.20 / $1,758.20 / $1,758.20
| Professional | | $1,758.20 | $1,758.20 | $1,758.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,163.23 / $1,550.10 / $2,887.50
| Facility | | $1,163.23 | $1,550.10 | $2,887.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,165.76 / $1,588.82 / $2,761.44
| Professional | | $1,165.76 | $1,588.82 | $2,761.44 |
- 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
- $952.77 / $1,299.50 / $2,035.07
| Professional | | $952.77 | $1,299.50 | $2,035.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.00 / $1,060.69 / $1,444.57
| Professional | | $924.00 | $1,060.69 | $1,444.57 |