- 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
- $2,030.62 / $2,328.23 / $2,781.96
| Professional | | $2,030.62 | $2,328.23 | $2,781.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,895.43 / $2,399.16 / $3,342.56
| Professional | | $1,895.43 | $2,399.16 | $3,342.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,912.49 / $1,912.49 / $1,912.49
| Facility | | $1,912.49 | $1,912.49 | $1,912.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.92 / $2,801.95 / $4,380.56
| Professional | | $2,137.92 | $2,801.95 | $4,380.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $60,063.64
| Facility | | $55.00 | $55.00 | $60,063.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,413.43 / $19,413.43 / $19,413.43
| Professional | | $19,413.43 | $19,413.43 | $19,413.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,057.29 / $2,579.29 / $4,874.83
| Facility | | $2,057.29 | $2,579.29 | $4,874.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,605.86 / $3,006.77 / $3,507.89
| Professional | | $2,605.86 | $3,006.77 | $3,507.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,902.39 / $2,078.48 / $3,418.86
| Professional | | $1,902.39 | $2,078.48 | $3,418.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,057.29 / $2,595.71 / $5,763.71
| Facility | | $2,057.29 | $2,595.71 | $5,763.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.92 / $2,902.74 / $4,391.21
| Professional | | $2,137.92 | $2,902.74 | $4,391.21 |
- 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
- $1,790.31 / $2,412.30 / $3,691.42
| Professional | | $1,790.31 | $2,412.30 | $3,691.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,710.79 / $1,959.32 / $2,678.33
| Professional | | $1,710.79 | $1,959.32 | $2,678.33 |