- 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
- $1,193.01 / $1,403.12 / $1,675.77
| Professional | | $1,193.01 | $1,403.12 | $1,675.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,138.55 / $1,436.69 / $2,007.82
| Professional | | $1,138.55 | $1,436.69 | $2,007.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.22 / $1,182.22 / $1,182.22
| Facility | | $1,182.22 | $1,182.22 | $1,182.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,284.17 / $1,673.03 / $2,628.64
| Professional | | $1,284.17 | $1,673.03 | $2,628.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $22,296.96
| Facility | | $55.00 | $55.00 | $22,296.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,763.92 / $8,962.79 / $10,599.23
| Professional | | $8,763.92 | $8,962.79 | $10,599.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.32 / $1,598.64 / $2,799.40
| Facility | | $1,283.32 | $1,598.64 | $2,799.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,566.80 / $1,807.85 / $2,109.15
| Professional | | $1,566.80 | $1,807.85 | $2,109.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,791.30 / $1,791.30 / $1,791.30
| Professional | | $1,791.30 | $1,791.30 | $1,791.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,283.32 / $1,629.07 / $3,173.25
| Facility | | $1,283.32 | $1,629.07 | $3,173.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.32 / $1,726.14 / $2,787.38
| Professional | | $1,283.32 | $1,726.14 | $2,787.38 |
- 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
- $1,052.08 / $1,386.49 / $2,188.19
| Professional | | $1,052.08 | $1,386.49 | $2,188.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.63 / $1,176.58 / $1,613.55
| Professional | | $1,028.63 | $1,176.58 | $1,613.55 |