- 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
- $1,121.69 / $1,266.34 / $1,830.50
| Professional | | $1,121.69 | $1,266.34 | $1,830.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,144.71 / $1,448.92 / $2,018.67
| Professional | | $1,144.71 | $1,448.92 | $2,018.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.45 / $1,147.45 / $1,147.45
| Facility | | $1,147.45 | $1,147.45 | $1,147.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,296.15 / $1,651.38 / $2,572.13
| Professional | | $1,296.15 | $1,651.38 | $2,572.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $15,455.77
| Facility | | $55.00 | $55.00 | $15,455.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,554.94 / $9,554.94 / $10,630.73
| Professional | | $9,554.94 | $9,554.94 | $10,630.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.02 / $1,567.46 / $2,700.84
| Facility | | $1,200.02 | $1,567.46 | $2,700.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,333.22 / $1,854.39 / $2,181.64
| Professional | | $1,333.22 | $1,854.39 | $2,181.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.30 / $2,386.90 / $4,611.17
| Professional | | $2,062.30 | $2,386.90 | $4,611.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.02 / $1,599.27 / $2,859.73
| Facility | | $1,200.02 | $1,599.27 | $2,859.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,290.53 / $1,697.08 / $2,643.90
| Professional | | $1,290.53 | $1,697.08 | $2,643.90 |
- 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
- $1,006.87 / $1,395.07 / $2,167.56
| Professional | | $1,006.87 | $1,395.07 | $2,167.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.42 / $1,180.97 / $1,625.35
| Professional | | $1,034.42 | $1,180.97 | $1,625.35 |