- 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
- $1,885.99 / $2,161.96 / $2,583.15
| Professional | | $1,885.99 | $2,161.96 | $2,583.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,760.00 / $2,227.73 / $3,103.73
| Professional | | $1,760.00 | $2,227.73 | $3,103.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,778.48 / $1,778.48 / $1,778.48
| Facility | | $1,778.48 | $1,778.48 | $1,778.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,993.58 / $2,615.35 / $4,123.00
| Professional | | $1,993.58 | $2,615.35 | $4,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $55,778.84
| Facility | | $55.00 | $55.00 | $55,778.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,631.00 / $24,631.00 / $24,631.00
| Professional | | $24,631.00 | $24,631.00 | $24,631.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.58 / $2,460.83 / $4,793.07
| Facility | | $1,993.58 | $2,460.83 | $4,793.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,419.59 / $2,791.83 / $3,257.14
| Professional | | $2,419.59 | $2,791.83 | $3,257.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,364.90 / $3,364.90 / $3,364.90
| Professional | | $3,364.90 | $3,364.90 | $3,364.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.58 / $2,537.31 / $5,102.30
| Facility | | $1,993.58 | $2,537.31 | $5,102.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,993.58 / $2,693.68 / $4,423.93
| Professional | | $1,993.58 | $2,693.68 | $4,423.93 |
- 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
- $1,631.54 / $2,151.84 / $3,414.25
| Professional | | $1,631.54 | $2,151.84 | $3,414.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,588.50 / $1,819.04 / $2,487.12
| Professional | | $1,588.50 | $1,819.04 | $2,487.12 |