- 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
- $1,344.23 / $1,537.80 / $1,836.77
| Professional | | $1,344.23 | $1,537.80 | $1,836.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.13 / $1,584.89 / $2,208.11
| Professional | | $1,252.13 | $1,584.89 | $2,208.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.65 / $1,293.65 / $1,293.65
| Facility | | $1,293.65 | $1,293.65 | $1,293.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,415.29 / $1,844.42 / $2,893.80
| Professional | | $1,415.29 | $1,844.42 | $2,893.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $32,024.16
| Facility | | $55.00 | $55.00 | $32,024.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,425.64 / $11,425.64 / $11,646.75
| Professional | | $11,425.64 | $11,425.64 | $11,646.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,410.70 / $1,751.45 / $3,720.00
| Facility | | $1,410.70 | $1,751.45 | $3,720.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,717.34 / $1,981.55 / $2,311.80
| Professional | | $1,717.34 | $1,981.55 | $2,311.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.67 / $1,410.70 / $2,551.39
| Professional | | $1,283.67 | $1,410.70 | $2,551.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,410.70 / $1,830.40 / $3,778.45
| Facility | | $1,410.70 | $1,830.40 | $3,778.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,410.70 / $1,906.13 / $3,121.46
| Professional | | $1,410.70 | $1,906.13 | $3,121.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $2,547.00 / $9,000.00
| Facility | | $495.00 | $2,547.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,153.71 / $1,514.25 / $2,411.25
| Professional | | $1,153.71 | $1,514.25 | $2,411.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,127.46 / $1,290.02 / $1,766.91
| Professional | | $1,127.46 | $1,290.02 | $1,766.91 |