- 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
- $1,955.63 / $2,242.07 / $2,678.90
| Professional | | $1,955.63 | $2,242.07 | $2,678.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,825.87 / $2,311.11 / $3,219.89
| Professional | | $1,825.87 | $2,311.11 | $3,219.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,842.72 / $1,842.72 / $1,842.72
| Facility | | $1,842.72 | $1,842.72 | $1,842.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,059.15 / $2,731.59 / $4,218.05
| Professional | | $2,059.15 | $2,731.59 | $4,218.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $57,838.30
| Facility | | $55.00 | $55.00 | $57,838.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,655.11 / $18,655.11 / $18,655.11
| Professional | | $18,655.11 | $18,655.11 | $18,655.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,980.80 / $2,484.46 / $4,688.79
| Facility | | $1,980.80 | $2,484.46 | $4,688.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,509.16 / $2,895.18 / $3,377.71
| Professional | | $2,509.16 | $2,895.18 | $3,377.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,833.88 / $2,003.63 / $3,293.15
| Professional | | $1,833.88 | $2,003.63 | $3,293.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,980.80 / $2,497.02 / $5,550.86
| Facility | | $1,980.80 | $2,497.02 | $5,550.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,059.15 / $2,814.67 / $4,225.63
| Professional | | $2,059.15 | $2,814.67 | $4,225.63 |
- 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
- $1,724.29 / $2,226.57 / $3,556.12
| Professional | | $1,724.29 | $2,226.57 | $3,556.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,647.30 / $1,886.48 / $2,579.03
| Professional | | $1,647.30 | $1,886.48 | $2,579.03 |