- 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
- $1,560.34 / $1,802.48 / $2,157.39
| Professional | | $1,560.34 | $1,802.48 | $2,157.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,466.67 / $1,856.44 / $2,615.98
| Professional | | $1,466.67 | $1,856.44 | $2,615.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,458.47 / $1,458.47 / $1,458.47
| Facility | | $1,458.47 | $1,458.47 | $1,458.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.91 / $2,193.94 / $3,493.98
| Professional | | $1,672.91 | $2,193.94 | $3,493.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $28,532.48
| Facility | | $55.00 | $55.00 | $28,532.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,193.12 / $11,481.28 / $13,721.78
| Professional | | $11,193.12 | $11,481.28 | $13,721.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.77 / $2,101.21 / $3,606.23
| Facility | | $1,665.77 | $2,101.21 | $3,606.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,016.74 / $2,327.01 / $2,714.85
| Professional | | $2,016.74 | $2,327.01 | $2,714.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,719.73 / $1,817.21 / $1,914.07
| Professional | | $1,719.73 | $1,817.21 | $1,914.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,665.77 / $2,108.94 / $4,088.85
| Facility | | $1,665.77 | $2,108.94 | $4,088.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,672.91 / $2,257.83 / $3,951.79
| Professional | | $1,672.91 | $2,257.83 | $3,951.79 |
- 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
- $1,454.64 / $1,900.73 / $3,037.03
| Professional | | $1,454.64 | $1,900.73 | $3,037.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,324.02 / $1,521.10 / $2,069.13
| Professional | | $1,324.02 | $1,521.10 | $2,069.13 |