- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $947.76 / $3,570.00 / $12,040.00
| Facility | | $947.76 | $3,570.00 | $12,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.82 / $1,041.52 / $1,534.98
| Professional | | $923.82 | $1,041.52 | $1,534.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.46 / $1,173.08 / $1,634.37
| Professional | | $920.46 | $1,173.08 | $1,634.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.42 / $954.42 / $974.98
| Facility | | $954.42 | $954.42 | $974.98 |
- 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
- $949.41 / $1,329.51 / $2,039.17
| Professional | | $949.41 | $1,329.51 | $2,039.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $9,084.32
| Facility | | $55.00 | $55.00 | $9,084.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,107.68 / $7,297.36 / $8,644.28
| Professional | | $7,107.68 | $7,297.36 | $8,644.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.86 / $1,145.33 / $2,051.42
| Facility | | $938.86 | $1,145.33 | $2,051.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,126.36 / $1,498.56 / $1,763.01
| Professional | | $1,126.36 | $1,498.56 | $1,763.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.83 / $1,911.50 / $3,729.23
| Professional | | $1,092.83 | $1,911.50 | $3,729.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $941.05 / $1,165.22 / $2,272.64
| Facility | | $941.05 | $1,165.22 | $2,272.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.74 / $1,378.66 / $2,508.26
| Professional | | $983.74 | $1,378.66 | $2,508.26 |
- 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
- $794.58 / $1,096.02 / $1,699.56
| Professional | | $794.58 | $1,096.02 | $1,699.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $835.93 / $972.51 / $1,314.48
| Professional | | $835.93 | $972.51 | $1,314.48 |