- 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
- $1,070.61 / $1,237.59 / $1,516.31
| Professional | | $1,070.61 | $1,237.59 | $1,516.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $998.42 / $1,272.43 / $1,772.79
| Professional | | $998.42 | $1,272.43 | $1,772.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.38 / $1,001.38 / $1,001.38
| Facility | | $1,001.38 | $1,001.38 | $1,001.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.54 / $1,564.32 / $2,710.77
| Professional | | $1,147.54 | $1,564.32 | $2,710.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $11,011.50
| Facility | | $55.00 | $55.00 | $11,011.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,151.00 / $10,151.00 / $10,151.00
| Professional | | $10,151.00 | $10,151.00 | $10,151.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,142.90 / $1,529.61 / $2,640.00
| Facility | | $1,142.90 | $1,529.61 | $2,640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,383.46 / $1,596.30 / $1,862.35
| Professional | | $1,383.46 | $1,596.30 | $1,862.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.30 / $1,412.30 / $1,412.30
| Professional | | $1,412.30 | $1,412.30 | $1,412.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,142.90 / $1,558.26 / $2,802.55
| Facility | | $1,142.90 | $1,558.26 | $2,802.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.13 / $1,588.92 / $2,772.18
| Professional | | $1,147.13 | $1,588.92 | $2,772.18 |
- 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
- $951.25 / $1,296.25 / $2,116.32
| Professional | | $951.25 | $1,296.25 | $2,116.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.26 / $1,043.22 / $1,419.55
| Professional | | $908.26 | $1,043.22 | $1,419.55 |