- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,893.00
| Facility | | $969.00 | $3,596.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,936.11 / $2,217.39 / $2,648.98
| Professional | | $1,936.11 | $2,217.39 | $2,648.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,804.94 / $2,284.61 / $3,182.98
| Professional | | $1,804.94 | $2,284.61 | $3,182.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,832.10 / $1,832.10 / $1,832.10
| Facility | | $1,832.10 | $1,832.10 | $1,832.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,044.84 / $2,662.79 / $4,156.38
| Professional | | $2,044.84 | $2,662.79 | $4,156.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $57,292.82
| Facility | | $55.00 | $55.00 | $57,292.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,779.00 / $23,779.00 / $23,779.00
| Professional | | $23,779.00 | $23,779.00 | $23,779.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.84 / $2,524.33 / $4,527.00
| Facility | | $2,044.84 | $2,524.33 | $4,527.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,484.34 / $2,866.55 / $3,344.30
| Professional | | $2,484.34 | $2,866.55 | $3,344.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,503.60 / $3,503.60 / $3,503.60
| Professional | | $3,503.60 | $3,503.60 | $3,503.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.84 / $2,559.86 / $5,031.89
| Facility | | $2,044.84 | $2,559.86 | $5,031.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,044.84 / $2,755.96 / $4,499.39
| Professional | | $2,044.84 | $2,755.96 | $4,499.39 |
- 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
- $1,669.07 / $2,190.66 / $3,546.78
| Professional | | $1,669.07 | $2,190.66 | $3,546.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,631.01 / $1,866.65 / $2,554.38
| Professional | | $1,631.01 | $1,866.65 | $2,554.38 |