- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,836.00
| Facility | | $969.00 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $982.89 / $1,086.95 / $1,505.29
| Professional | | $982.89 | $1,086.95 | $1,505.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,039.00 / $1,743.91 / $4,996.47
| Facility | | $1,039.00 | $1,743.91 | $4,996.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.40 / $1,183.99 / $1,649.57
| Professional | | $935.40 | $1,183.99 | $1,649.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $911.12 / $911.12 / $911.12
| Facility | | $911.12 | $911.12 | $911.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.35 / $1,388.96 / $2,146.76
| Professional | | $1,053.35 | $1,388.96 | $2,146.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $9,397.76
| Facility | | $55.00 | $55.00 | $9,397.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,505.04 / $7,669.52 / $8,560.73
| Professional | | $7,505.04 | $7,669.52 | $8,560.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.04 / $1,350.56 / $2,284.44
| Facility | | $1,017.04 | $1,350.56 | $2,284.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,100.88 / $1,531.22 / $1,801.44
| Professional | | $1,100.88 | $1,531.22 | $1,801.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,493.00 / $1,493.00 / $1,493.00
| Professional | | $1,493.00 | $1,493.00 | $1,493.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,017.04 / $1,365.14 / $2,445.64
| Facility | | $1,017.04 | $1,365.14 | $2,445.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,053.35 / $1,410.28 / $2,238.12
| Professional | | $1,053.35 | $1,410.28 | $2,238.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,000.00 / $8,759.00
| Facility | | $385.00 | $2,000.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.24 / $1,184.21 / $1,830.14
| Professional | | $861.24 | $1,184.21 | $1,830.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.15 / $978.43 / $1,350.95
| Professional | | $854.15 | $978.43 | $1,350.95 |