- 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
- $2,075.86 / $2,380.35 / $2,844.29
| Professional | | $2,075.86 | $2,380.35 | $2,844.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,937.60 / $2,452.53 / $3,416.93
| Professional | | $1,937.60 | $2,452.53 | $3,416.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,954.46 / $1,954.46 / $1,954.46
| Facility | | $1,954.46 | $1,954.46 | $1,954.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,195.77 / $2,855.93 / $4,476.93
| Professional | | $2,195.77 | $2,855.93 | $4,476.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $49,592.34
| Facility | | $55.00 | $55.00 | $49,592.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,881.00 / $20,881.00 / $20,881.00
| Professional | | $20,881.00 | $20,881.00 | $20,881.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,151.61 / $2,643.74 / $4,738.50
| Facility | | $2,151.61 | $2,643.74 | $4,738.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,663.90 / $3,073.73 / $3,586.01
| Professional | | $2,663.90 | $3,073.73 | $3,586.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,945.37 / $2,195.77 / $3,541.81
| Professional | | $1,945.37 | $2,195.77 | $3,541.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,151.61 / $2,651.40 / $5,401.74
| Facility | | $2,151.61 | $2,651.40 | $5,401.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,195.77 / $2,929.75 / $4,905.21
| Professional | | $2,195.77 | $2,929.75 | $4,905.21 |
- 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
- $1,791.74 / $2,358.53 / $3,772.64
| Professional | | $1,791.74 | $2,358.53 | $3,772.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.89 / $2,003.06 / $2,737.92
| Professional | | $1,748.89 | $2,003.06 | $2,737.92 |