- 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
- $1,393.46 / $1,541.82 / $2,126.96
| Professional | | $1,393.46 | $1,541.82 | $2,126.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,131.91 / $1,558.48 / $2,903.71
| Professional | | $1,131.91 | $1,558.48 | $2,903.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,286.59 / $1,286.59 / $1,286.59
| Facility | | $1,286.59 | $1,286.59 | $1,286.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,489.88 / $1,968.94 / $2,983.48
| Professional | | $1,489.88 | $1,968.94 | $2,983.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $13,276.16
| Facility | | $55.00 | $55.00 | $13,276.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,606.08 / $10,849.84 / $12,089.33
| Professional | | $10,606.08 | $10,849.84 | $12,089.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.08 / $1,911.31 / $3,240.25
| Facility | | $1,442.08 | $1,911.31 | $3,240.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,555.26 / $2,163.21 / $2,544.96
| Professional | | $1,555.26 | $2,163.21 | $2,544.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,446.10 / $2,169.16 / $3,206.20
| Professional | | $1,446.10 | $2,169.16 | $3,206.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,442.08 / $1,938.14 / $3,469.10
| Facility | | $1,442.08 | $1,938.14 | $3,469.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,489.88 / $2,008.94 / $3,074.29
| Professional | | $1,489.88 | $2,008.94 | $3,074.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $2,064.00 / $8,759.00
| Facility | | $385.00 | $2,064.00 | $8,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,221.27 / $1,679.25 / $2,617.98
| Professional | | $1,221.27 | $1,679.25 | $2,617.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,206.70 / $1,382.88 / $1,908.39
| Professional | | $1,206.70 | $1,382.88 | $1,908.39 |