- 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
- $1,354.25 / $1,517.46 / $2,247.42
| Professional | | $1,354.25 | $1,517.46 | $2,247.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,357.40 / $1,712.84 / $2,393.75
| Professional | | $1,357.40 | $1,712.84 | $2,393.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.09 / $1,351.09 / $1,401.70
| Facility | | $1,351.09 | $1,351.09 | $1,401.70 |
- 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
- $1,403.62 / $1,923.08 / $3,012.66
| Professional | | $1,403.62 | $1,923.08 | $3,012.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $13,287.76
| Facility | | $55.00 | $55.00 | $13,287.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,403.36 / $10,649.84 / $12,722.33
| Professional | | $10,403.36 | $10,649.84 | $12,722.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,400.52 / $1,711.24 / $3,007.83
| Facility | | $1,400.52 | $1,711.24 | $3,007.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,654.59 / $2,201.32 / $2,589.79
| Professional | | $1,654.59 | $2,201.32 | $2,589.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,848.50 / $3,727.50
| Professional | | $7.00 | $1,848.50 | $3,727.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,405.04 / $1,741.43 / $3,354.21
| Facility | | $1,405.04 | $1,741.43 | $3,354.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,450.61 / $2,050.84 / $3,675.24
| Professional | | $1,450.61 | $2,050.84 | $3,675.24 |
- 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
- $1,170.90 / $1,623.01 / $2,543.17
| Professional | | $1,170.90 | $1,623.01 | $2,543.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.95 / $1,426.92 / $1,925.14
| Professional | | $1,227.95 | $1,426.92 | $1,925.14 |