- 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
- $1,474.75 / $1,718.30 / $2,311.81
| Professional | | $1,474.75 | $1,718.30 | $2,311.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,618.98 / $2,702.71 / $6,966.61
| Facility | | $1,618.98 | $2,702.71 | $6,966.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,408.17 / $1,408.17 / $1,408.17
| Facility | | $1,408.17 | $1,408.17 | $1,408.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.46 / $2,163.07 / $3,338.95
| Professional | | $1,635.46 | $2,163.07 | $3,338.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $14,580.16
| Facility | | $55.00 | $55.00 | $14,580.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,649.68 / $11,913.92 / $13,277.33
| Professional | | $11,649.68 | $11,913.92 | $13,277.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,564.50 / $2,089.96 / $3,558.84
| Facility | | $1,564.50 | $2,089.96 | $3,558.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.26 / $2,376.03 / $2,795.33
| Professional | | $1,708.26 | $2,376.03 | $2,795.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,323.90 / $2,323.90 / $2,323.90
| Professional | | $2,323.90 | $2,323.90 | $2,323.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,564.50 / $2,091.63 / $4,052.81
| Facility | | $1,564.50 | $2,091.63 | $4,052.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,635.46 / $2,197.44 / $3,513.08
| Professional | | $1,635.46 | $2,197.44 | $3,513.08 |
- 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
- $1,341.95 / $1,845.18 / $2,922.10
| Professional | | $1,341.95 | $1,845.18 | $2,922.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,325.40 / $1,519.43 / $2,095.89
| Professional | | $1,325.40 | $1,519.43 | $2,095.89 |