- 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
- $1,931.08 / $2,259.16 / $2,716.31
| Professional | | $1,931.08 | $2,259.16 | $2,716.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,851.11 / $2,343.05 / $3,264.40
| Professional | | $1,851.11 | $2,343.05 | $3,264.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,867.93 / $1,867.93 / $1,867.93
| Facility | | $1,867.93 | $1,867.93 | $1,867.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,096.60 / $2,733.24 / $4,067.91
| Professional | | $2,096.60 | $2,733.24 | $4,067.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $58,642.22
| Facility | | $55.00 | $55.00 | $58,642.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,159.00 / $22,159.00 / $22,159.00
| Professional | | $22,159.00 | $22,159.00 | $22,159.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.72 / $2,518.71 / $4,794.80
| Facility | | $1,982.72 | $2,518.71 | $4,794.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,544.05 / $2,935.44 / $3,424.68
| Professional | | $2,544.05 | $2,935.44 | $3,424.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,887.20 / $2,887.20 / $2,887.20
| Professional | | $2,887.20 | $2,887.20 | $2,887.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,982.72 / $2,522.44 / $5,072.52
| Facility | | $1,982.72 | $2,522.44 | $5,072.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,086.53 / $2,823.95 / $4,276.14
| Professional | | $2,086.53 | $2,823.95 | $4,276.14 |
- 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
- $1,697.93 / $2,218.63 / $3,600.48
| Professional | | $1,697.93 | $2,218.63 | $3,600.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,670.21 / $1,912.78 / $2,614.88
| Professional | | $1,670.21 | $1,912.78 | $2,614.88 |