- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,570.00 / $10,893.00
| Facility | | $945.00 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,332.83 / $1,504.53 / $2,264.03
| Professional | | $1,332.83 | $1,504.53 | $2,264.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,317.26 / $1,678.79 / $2,338.92
| Professional | | $1,317.26 | $1,678.79 | $2,338.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,369.20 / $1,369.20 / $1,417.24
| Facility | | $1,369.20 | $1,369.20 | $1,417.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,024.00 / $4,619.00
| Facility | | $900.00 | $2,024.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,371.10 / $1,916.96 / $2,979.58
| Professional | | $1,371.10 | $1,916.96 | $2,979.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $13,005.92
| Facility | | $55.00 | $55.00 | $13,005.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,198.32 / $10,442.71 / $12,423.75
| Professional | | $10,198.32 | $10,442.71 | $12,423.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,340.67 / $1,672.51 / $3,022.50
| Facility | | $1,340.67 | $1,672.51 | $3,022.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,618.88 / $2,153.81 / $2,533.90
| Professional | | $1,618.88 | $2,153.81 | $2,533.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,727.30 / $3,615.00
| Professional | | $7.00 | $1,727.30 | $3,615.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,347.30 / $1,690.64 / $3,297.90
| Facility | | $1,347.30 | $1,690.64 | $3,297.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,421.50 / $2,034.76 / $3,608.06
| Professional | | $1,421.50 | $2,034.76 | $3,608.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.16 / $1,595.72 / $2,484.91
| Professional | | $1,177.16 | $1,595.72 | $2,484.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,201.45 / $1,396.52 / $1,883.70
| Professional | | $1,201.45 | $1,396.52 | $1,883.70 |