- 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
- $1,903.76 / $2,271.85 / $3,162.77
| Professional | | $1,903.76 | $2,271.85 | $3,162.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,887.43 / $2,389.03 / $2,722.00
| Professional | | $1,887.43 | $2,389.03 | $2,722.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,769.08 / $1,769.08 / $1,769.08
| Facility | | $1,769.08 | $1,769.08 | $1,769.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,046.00 / $2,718.71 / $4,224.35
| Professional | | $2,046.00 | $2,718.71 | $4,224.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $16,236.43
| Facility | | $55.00 | $55.00 | $16,236.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,696.08 / $15,123.84 / $17,095.13
| Professional | | $14,696.08 | $15,123.84 | $17,095.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,973.27 / $2,491.88 / $4,542.91
| Facility | | $1,973.27 | $2,491.88 | $4,542.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,175.79 / $3,026.32 / $3,560.38
| Professional | | $2,175.79 | $3,026.32 | $3,560.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,379.30 / $2,379.30 / $2,379.30
| Professional | | $2,379.30 | $2,379.30 | $2,379.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.81 / $2,534.30 / $4,963.63
| Facility | | $1,971.81 | $2,534.30 | $4,963.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,070.17 / $2,750.45 / $4,314.53
| Professional | | $2,070.17 | $2,750.45 | $4,314.53 |
- 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
- $1,680.64 / $2,335.46 / $3,586.23
| Professional | | $1,680.64 | $2,335.46 | $3,586.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,688.16 / $1,916.83 / $2,671.20
| Professional | | $1,688.16 | $1,916.83 | $2,671.20 |