- 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
- $1,053.00 / $1,184.64 / $1,747.14
| Professional | | $1,053.00 | $1,184.64 | $1,747.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,059.45 / $1,341.35 / $1,868.32
| Professional | | $1,059.45 | $1,341.35 | $1,868.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,064.07 / $1,064.07 / $1,100.27
| Facility | | $1,064.07 | $1,064.07 | $1,100.27 |
- 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
- $1,055.03 / $1,504.69 / $2,344.55
| Professional | | $1,055.03 | $1,504.69 | $2,344.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $10,381.28
| Facility | | $55.00 | $55.00 | $10,381.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,126.72 / $8,320.40 / $9,926.70
| Professional | | $8,126.72 | $8,320.40 | $9,926.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.89 / $1,319.05 / $2,345.64
| Facility | | $1,069.89 | $1,319.05 | $2,345.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,291.53 / $1,718.30 / $2,021.53
| Professional | | $1,291.53 | $1,718.30 | $2,021.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,305.09 / $2,920.00
| Professional | | $7.00 | $1,305.09 | $2,920.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,077.85 / $1,326.16 / $2,613.61
| Facility | | $1,077.85 | $1,326.16 | $2,613.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,107.09 / $1,589.01 / $2,868.48
| Professional | | $1,107.09 | $1,589.01 | $2,868.48 |
- 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
- $908.92 / $1,230.34 / $1,947.51
| Professional | | $908.92 | $1,230.34 | $1,947.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $958.51 / $1,114.08 / $1,503.64
| Professional | | $958.51 | $1,114.08 | $1,503.64 |