- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $11,675.40
| Facility | | $969.00 | $3,596.00 | $11,675.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,614.32 / $1,880.82 / $2,534.32
| Professional | | $1,614.32 | $1,880.82 | $2,534.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,761.24 / $2,951.63 / $9,154.79
| Facility | | $1,761.24 | $2,951.63 | $9,154.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,540.10 / $1,540.10 / $1,540.10
| Facility | | $1,540.10 | $1,540.10 | $1,540.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,789.56 / $2,366.17 / $3,655.89
| Professional | | $1,789.56 | $2,366.17 | $3,655.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $15,958.24
| Facility | | $55.00 | $55.00 | $15,958.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,890.00 / $13,038.08 / $14,530.58
| Professional | | $12,890.00 | $13,038.08 | $14,530.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.98 / $2,285.69 / $3,899.61
| Facility | | $1,711.98 | $2,285.69 | $3,899.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.79 / $2,600.71 / $3,059.66
| Professional | | $1,869.79 | $2,600.71 | $3,059.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,618.19 / $2,618.19 / $2,618.19
| Professional | | $2,618.19 | $2,618.19 | $2,618.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,711.98 / $2,293.44 / $4,436.38
| Facility | | $1,711.98 | $2,293.44 | $4,436.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,789.56 / $2,407.36 / $3,973.63
| Professional | | $1,789.56 | $2,407.36 | $3,973.63 |
- 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
- $1,470.14 / $2,021.45 / $3,201.24
| Professional | | $1,470.14 | $2,021.45 | $3,201.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,450.74 / $1,663.52 / $2,293.96
| Professional | | $1,450.74 | $1,663.52 | $2,293.96 |