- 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
- $1,812.80 / $2,075.73 / $2,480.28
| Professional | | $1,812.80 | $2,075.73 | $2,480.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,683.67 / $2,131.11 / $2,969.12
| Professional | | $1,683.67 | $2,131.11 | $2,969.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,731.42 / $1,731.42 / $1,731.42
| Facility | | $1,731.42 | $1,731.42 | $1,731.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,899.67 / $2,489.85 / $3,926.19
| Professional | | $1,899.67 | $2,489.85 | $3,926.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $43,196.16
| Facility | | $55.00 | $55.00 | $43,196.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,387.00 / $17,387.00 / $17,387.00
| Professional | | $17,387.00 | $17,387.00 | $17,387.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,899.67 / $2,364.11 / $4,500.00
| Facility | | $1,899.67 | $2,364.11 | $4,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,314.46 / $2,670.53 / $3,115.61
| Professional | | $2,314.46 | $2,670.53 | $3,115.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,722.83 / $1,899.67 / $3,086.63
| Professional | | $1,722.83 | $1,899.67 | $3,086.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,899.67 / $2,434.29 / $4,693.81
| Facility | | $1,899.67 | $2,434.29 | $4,693.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,899.67 / $2,563.84 / $4,239.45
| Professional | | $1,899.67 | $2,563.84 | $4,239.45 |
- 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
- $1,563.11 / $2,051.58 / $3,267.80
| Professional | | $1,563.11 | $2,051.58 | $3,267.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.48 / $1,740.00 / $2,382.17
| Professional | | $1,519.48 | $1,740.00 | $2,382.17 |