- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $3,839.00 / $8,247.00
| Facility | | $1,020.00 | $3,839.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $973.99 / $1,110.68 / $1,773.93
| Professional | | $973.99 | $1,110.68 | $1,773.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,058.35 / $6,182.00 / $17,094.48
| Facility | | $5,058.35 | $6,182.00 | $17,094.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.98 / $1,205.83 / $1,205.83
| Professional | | $1,161.98 | $1,205.83 | $1,205.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.21 / $1,484.41 / $2,352.26
| Professional | | $1,096.21 | $1,484.41 | $2,352.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.12 / $1,825.33 / $1,825.33
| Professional | | $1,373.12 | $1,825.33 | $1,825.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,324.51 / $15,324.51 / $15,324.51
| Facility | | $15,324.51 | $15,324.51 | $15,324.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,037.80 / $1,187.34 / $2,161.07
| Professional | | $1,037.80 | $1,187.34 | $2,161.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.00 / $1,411.90 / $2,953.00
| Professional | | $3.00 | $1,411.90 | $2,953.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.85 / $1,501.27 / $2,507.00
| Professional | | $1,108.85 | $1,501.27 | $2,507.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.72 / $1,148.72 / $1,205.28
| Facility | | $1,148.72 | $1,148.72 | $1,205.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,110.35 / $1,157.75 / $1,206.74
| Professional | | $1,110.35 | $1,157.75 | $1,206.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,334.00 / $2,824.00 / $5,678.00
| Facility | | $1,334.00 | $2,824.00 | $5,678.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,063.13 / $1,439.49 / $2,339.64
| Professional | | $1,063.13 | $1,439.49 | $2,339.64 |