- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,002.00 / $3,682.00 / $12,729.00
| Facility | | $1,002.00 | $3,682.00 | $12,729.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,001.31 / $2,362.35 / $3,426.68
| Professional | | $2,001.31 | $2,362.35 | $3,426.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,500.92 / $4,674.35 / $8,872.32
| Facility | | $2,500.92 | $4,674.35 | $8,872.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $857.21 / $857.21 / $1,008.48
| Professional | | $857.21 | $857.21 | $1,008.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,465.00 / $3,134.51 / $4,811.14
| Professional | | $2,465.00 | $3,134.51 | $4,811.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,500.00 / $26,542.00 / $26,542.00
| Facility | | $11,500.00 | $26,542.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,595.87 / $22,785.23 / $23,499.70
| Professional | | $22,595.87 | $22,785.23 | $23,499.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.31 / $2,774.19 / $4,013.72
| Facility | | $2,001.31 | $2,774.19 | $4,013.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,519.34 / $5,306.00 / $6,634.00
| Professional | | $2,519.34 | $5,306.00 | $6,634.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,001.31 / $2,783.87 / $4,291.51
| Facility | | $2,001.31 | $2,783.87 | $4,291.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,472.48 / $3,283.12 / $4,906.18
| Professional | | $2,472.48 | $3,283.12 | $4,906.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,634.00 / $4,345.00 / $10,600.00
| Facility | | $1,634.00 | $4,345.00 | $10,600.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,086.88 / $2,782.51 / $4,063.43
| Professional | | $2,086.88 | $2,782.51 | $4,063.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,437.84 / $2,437.84 / $3,291.08
| Professional | | $2,437.84 | $2,437.84 | $3,291.08 |