- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,146.27 / $3,766.00 / $13,004.00
| Facility | | $1,146.27 | $3,766.00 | $13,004.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.30 / $1,244.77 / $1,868.52
| Professional | | $1,087.30 | $1,244.77 | $1,868.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,245.05 / $2,077.86 / $5,480.00
| Facility | | $1,245.05 | $2,077.86 | $5,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.07 / $1,353.41 / $2,013.79
| Professional | | $1,010.07 | $1,353.41 | $2,013.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,069.86 / $1,069.86 / $1,069.86
| Facility | | $1,069.86 | $1,069.86 | $1,069.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,244.75 / $1,692.35 / $2,603.85
| Professional | | $1,244.75 | $1,692.35 | $2,603.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $9,822.46
| Facility | | $55.00 | $55.00 | $9,822.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,900.40 / $9,166.95 / $10,419.37
| Professional | | $8,900.40 | $9,166.95 | $10,419.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.39 / $1,611.80 / $2,719.18
| Facility | | $1,198.39 | $1,611.80 | $2,719.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.27 / $1,840.54 / $2,165.35
| Professional | | $1,323.27 | $1,840.54 | $2,165.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,278.19 / $1,369.31 / $1,491.22
| Professional | | $1,278.19 | $1,369.31 | $1,491.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,198.83 / $1,641.15 / $2,783.31
| Facility | | $1,198.83 | $1,641.15 | $2,783.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.79 / $1,730.68 / $2,787.21
| Professional | | $1,249.79 | $1,730.68 | $2,787.21 |
- 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
- $1,049.20 / $1,393.94 / $2,200.00
| Professional | | $1,049.20 | $1,393.94 | $2,200.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,026.70 / $1,174.39 / $1,618.42
| Professional | | $1,026.70 | $1,174.39 | $1,618.42 |