- 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
- $1,585.44 / $1,804.42 / $2,830.35
| Professional | | $1,585.44 | $1,804.42 | $2,830.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,596.25 / $2,020.47 / $2,814.96
| Professional | | $1,596.25 | $2,020.47 | $2,814.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,582.32 / $1,582.32 / $1,643.36
| Facility | | $1,582.32 | $1,582.32 | $1,643.36 |
- 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
- $1,662.87 / $2,305.80 / $3,559.97
| Professional | | $1,662.87 | $2,305.80 | $3,559.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $15,596.24
| Facility | | $55.00 | $55.00 | $15,596.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,211.20 / $12,510.56 / $14,937.68
| Professional | | $12,211.20 | $12,510.56 | $14,937.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,663.12 / $2,090.71 / $3,664.76
| Facility | | $1,663.12 | $2,090.71 | $3,664.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,942.50 / $2,584.37 / $3,040.43
| Professional | | $1,942.50 | $2,584.37 | $3,040.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $2,364.40 / $4,379.89
| Professional | | $7.00 | $2,364.40 | $4,379.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,668.32 / $2,122.37 / $3,945.43
| Facility | | $1,668.32 | $2,122.37 | $3,945.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,729.46 / $2,446.98 / $4,319.32
| Professional | | $1,729.46 | $2,446.98 | $4,319.32 |
- 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
- $1,397.89 / $1,917.11 / $2,992.80
| Professional | | $1,397.89 | $1,917.11 | $2,992.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,441.62 / $1,675.11 / $2,259.75
| Professional | | $1,441.62 | $1,675.11 | $2,259.75 |