- 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
- $2,043.31 / $2,343.83 / $2,801.05
| Professional | | $2,043.31 | $2,343.83 | $2,801.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,908.05 / $2,415.13 / $3,364.82
| Professional | | $1,908.05 | $2,415.13 | $3,364.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,919.00 / $1,919.00 / $1,919.00
| Facility | | $1,919.00 | $1,919.00 | $1,919.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,161.07 / $2,904.63 / $4,584.96
| Professional | | $2,161.07 | $2,904.63 | $4,584.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $60,392.54
| Facility | | $55.00 | $55.00 | $60,392.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,205.00 / $24,205.00 / $24,205.00
| Professional | | $24,205.00 | $24,205.00 | $24,205.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,161.07 / $2,674.18 / $4,710.14
| Facility | | $2,161.07 | $2,674.18 | $4,710.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,620.58 / $3,023.75 / $3,527.70
| Professional | | $2,620.58 | $3,023.75 | $3,527.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,396.20 / $3,396.20 / $3,396.20
| Professional | | $3,396.20 | $3,396.20 | $3,396.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,161.07 / $2,784.77 / $5,319.36
| Facility | | $2,161.07 | $2,784.77 | $5,319.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,161.07 / $2,929.79 / $4,820.83
| Professional | | $2,161.07 | $2,929.79 | $4,820.83 |
- 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
- $1,771.57 / $2,403.00 / $3,764.58
| Professional | | $1,771.57 | $2,403.00 | $3,764.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,720.45 / $1,971.08 / $2,693.09
| Professional | | $1,720.45 | $1,971.08 | $2,693.09 |