- 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
- $1,550.83 / $1,724.95 / $2,387.38
| Professional | | $1,550.83 | $1,724.95 | $2,387.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,482.37 / $1,876.31 / $2,614.13
| Professional | | $1,482.37 | $1,876.31 | $2,614.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,434.45 / $1,434.45 / $1,434.45
| Facility | | $1,434.45 | $1,434.45 | $1,434.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,667.58 / $2,206.00 / $3,399.21
| Professional | | $1,667.58 | $2,206.00 | $3,399.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $13,006.56
| Facility | | $55.00 | $55.00 | $13,006.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,536.30 / $15,376.51 / $15,883.93
| Professional | | $13,536.30 | $15,376.51 | $15,883.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.57 / $2,110.12 / $3,630.67
| Facility | | $1,581.57 | $2,110.12 | $3,630.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,741.70 / $2,422.54 / $2,850.05
| Professional | | $1,741.70 | $2,422.54 | $2,850.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,422.19 / $2,422.19 / $2,422.19
| Professional | | $2,422.19 | $2,422.19 | $2,422.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,581.57 / $2,142.06 / $3,881.14
| Facility | | $1,581.57 | $2,142.06 | $3,881.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,667.58 / $2,240.94 / $3,441.93
| Professional | | $1,667.58 | $2,240.94 | $3,441.93 |
- 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
- $1,368.52 / $1,799.60 / $2,908.11
| Professional | | $1,368.52 | $1,799.60 | $2,908.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,351.35 / $1,549.50 / $2,136.79
| Professional | | $1,351.35 | $1,549.50 | $2,136.79 |