- 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
- $1,884.03 / $2,226.40 / $2,905.34
| Professional | | $1,884.03 | $2,226.40 | $2,905.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,812.63 / $2,294.35 / $3,196.55
| Professional | | $1,812.63 | $2,294.35 | $3,196.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,838.17 / $1,838.17 / $1,838.17
| Facility | | $1,838.17 | $1,838.17 | $1,838.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.50 / $2,674.48 / $4,174.31
| Professional | | $2,053.50 | $2,674.48 | $4,174.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $57,521.88
| Facility | | $55.00 | $55.00 | $57,521.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,029.00 / $20,556.45 / $20,556.45
| Professional | | $20,029.00 | $20,556.45 | $20,556.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.46 / $2,534.62 / $4,500.00
| Facility | | $2,043.46 | $2,534.62 | $4,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,494.42 / $2,878.19 / $3,357.88
| Professional | | $2,494.42 | $2,878.19 | $3,357.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,112.60 / $3,112.60 / $3,112.60
| Professional | | $3,112.60 | $3,112.60 | $3,112.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,043.46 / $2,656.52 / $5,053.35
| Facility | | $2,043.46 | $2,656.52 | $5,053.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.50 / $2,759.30 / $4,451.02
| Professional | | $2,053.50 | $2,759.30 | $4,451.02 |
- 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
- $1,676.29 / $2,200.79 / $3,519.26
| Professional | | $1,676.29 | $2,200.79 | $3,519.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,637.63 / $1,874.41 / $2,564.64
| Professional | | $1,637.63 | $1,874.41 | $2,564.64 |