- 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
- $1,902.72 / $2,177.41 / $2,605.34
| Professional | | $1,902.72 | $2,177.41 | $2,605.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,772.93 / $2,244.10 / $3,126.53
| Professional | | $1,772.93 | $2,244.10 | $3,126.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,808.66 / $1,808.66 / $1,808.66
| Facility | | $1,808.66 | $1,808.66 | $1,808.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.51 / $2,685.68 / $4,079.65
| Professional | | $2,008.51 | $2,685.68 | $4,079.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $56,356.30
| Facility | | $55.00 | $55.00 | $56,356.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,568.00 / $25,568.00 / $25,568.00
| Professional | | $25,568.00 | $25,568.00 | $25,568.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.51 / $2,568.52 / $5,465.98
| Facility | | $2,008.51 | $2,568.52 | $5,465.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,442.71 / $2,818.52 / $3,288.27
| Professional | | $2,442.71 | $2,818.52 | $3,288.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,244.60 / $3,244.60 / $3,244.60
| Professional | | $3,244.60 | $3,244.60 | $3,244.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,008.51 / $2,595.34 / $5,465.98
| Facility | | $2,008.51 | $2,595.34 | $5,465.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.51 / $2,721.76 / $4,159.97
| Professional | | $2,008.51 | $2,721.76 | $4,159.97 |
- 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
- $1,637.31 / $2,148.96 / $3,437.43
| Professional | | $1,637.31 | $2,148.96 | $3,437.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,603.68 / $1,834.46 / $2,512.30
| Professional | | $1,603.68 | $1,834.46 | $2,512.30 |