- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,570.00 / $10,893.00
| Facility | | $969.00 | $3,570.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,961.58 / $2,273.89 / $2,717.38
| Professional | | $1,961.58 | $2,273.89 | $2,717.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,850.80 / $2,342.67 / $3,263.86
| Professional | | $1,850.80 | $2,342.67 | $3,263.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,862.03 / $1,862.03 / $1,862.03
| Facility | | $1,862.03 | $1,862.03 | $1,862.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.26 / $2,735.14 / $4,280.43
| Professional | | $2,097.26 | $2,735.14 | $4,280.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $58,607.90
| Facility | | $55.00 | $55.00 | $58,607.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,369.00 / $20,369.00 / $20,369.00
| Professional | | $20,369.00 | $20,369.00 | $20,369.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.26 / $2,588.00 / $4,562.01
| Facility | | $2,097.26 | $2,588.00 | $4,562.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,543.21 / $2,934.48 / $3,423.56
| Professional | | $2,543.21 | $2,934.48 | $3,423.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,852.49 / $2,097.26 / $3,382.36
| Professional | | $1,852.49 | $2,097.26 | $3,382.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,097.26 / $2,680.64 / $5,158.89
| Facility | | $2,097.26 | $2,680.64 | $5,158.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.26 / $2,817.10 / $4,622.35
| Professional | | $2,097.26 | $2,817.10 | $4,622.35 |
- 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
- $1,702.47 / $2,246.31 / $3,636.88
| Professional | | $1,702.47 | $2,246.31 | $3,636.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,669.66 / $1,912.76 / $2,613.56
| Professional | | $1,669.66 | $1,912.76 | $2,613.56 |