- 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
- $1,933.21 / $2,330.25 / $3,050.52
| Professional | | $1,933.21 | $2,330.25 | $3,050.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.68 / $2,451.36 / $2,793.02
| Professional | | $1,936.68 | $2,451.36 | $2,793.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,813.57 / $1,813.57 / $1,813.57
| Facility | | $1,813.57 | $1,813.57 | $1,813.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,093.66 / $2,790.74 / $4,335.26
| Professional | | $2,093.66 | $2,790.74 | $4,335.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $16,665.18
| Facility | | $55.00 | $55.00 | $16,665.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15,085.76 / $15,524.88 / $17,546.70
| Professional | | $15,085.76 | $15,524.88 | $17,546.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.48 / $2,446.76 / $4,662.10
| Facility | | $1,995.48 | $2,446.76 | $4,662.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,233.42 / $3,106.50 / $3,654.70
| Professional | | $2,233.42 | $3,106.50 | $3,654.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,297.50 / $2,297.50 / $2,297.50
| Professional | | $2,297.50 | $2,297.50 | $2,297.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,990.44 / $2,465.63 / $5,014.72
| Facility | | $1,990.44 | $2,465.63 | $5,014.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,100.88 / $2,823.51 / $4,427.85
| Professional | | $2,100.88 | $2,823.51 | $4,427.85 |
- 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
- $1,704.85 / $2,367.01 / $3,660.50
| Professional | | $1,704.85 | $2,367.01 | $3,660.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,732.88 / $1,968.08 / $2,741.76
| Professional | | $1,732.88 | $1,968.08 | $2,741.76 |