- 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 / $2,675.43 / $4,438.92
| Professional | | $1,993.58 | $2,675.43 | $4,438.92 |
- 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
- $20,881.00 / $22,284.20 / $22,284.20
| Professional | | $20,881.00 | $22,284.20 | $22,284.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.58 / $2,501.31 / $4,947.04
| Facility | | $1,993.58 | $2,501.31 | $4,947.04 |
- 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
- $3,254.70 / $3,254.70 / $3,254.70
| Professional | | $3,254.70 | $3,254.70 | $3,254.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,993.58 / $2,591.65 / $4,950.00
| Facility | | $1,993.58 | $2,591.65 | $4,950.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,993.58 / $2,707.71 / $4,537.56
| Professional | | $1,993.58 | $2,707.71 | $4,537.56 |
- 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 / $3,442.94
| Professional | | $1,631.54 | $2,151.84 | $3,442.94 |
- 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 |