- 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
- $1,935.68 / $2,219.05 / $2,651.43
| Professional | | $1,935.68 | $2,219.05 | $2,651.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,806.79 / $2,286.94 / $3,186.24
| Professional | | $1,806.79 | $2,286.94 | $3,186.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,824.71 / $1,824.71 / $1,824.71
| Facility | | $1,824.71 | $1,824.71 | $1,824.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,046.86 / $2,697.13 / $4,372.46
| Professional | | $2,046.86 | $2,697.13 | $4,372.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $57,258.50
| Facility | | $55.00 | $55.00 | $57,258.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,205.00 / $25,948.28 / $25,948.28
| Professional | | $24,205.00 | $25,948.28 | $25,948.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,046.86 / $2,590.05 / $4,710.14
| Facility | | $2,046.86 | $2,590.05 | $4,710.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,483.92 / $2,866.07 / $3,343.74
| Professional | | $2,483.92 | $2,866.07 | $3,343.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,602.40 / $3,602.40 / $3,602.40
| Professional | | $3,602.40 | $3,602.40 | $3,602.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,046.86 / $2,648.61 / $5,037.91
| Facility | | $2,046.86 | $2,648.61 | $5,037.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,046.86 / $2,765.27 / $4,458.34
| Professional | | $2,046.86 | $2,765.27 | $4,458.34 |
- 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
- $1,674.85 / $2,169.94 / $3,473.58
| Professional | | $1,674.85 | $2,169.94 | $3,473.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,630.73 / $1,867.50 / $2,553.15
| Professional | | $1,630.73 | $1,867.50 | $2,553.15 |