- 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
- $1,802.09 / $2,127.62 / $2,543.73
| Professional | | $1,802.09 | $2,127.62 | $2,543.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,717.42 / $2,188.77 / $2,982.60
| Professional | | $1,717.42 | $2,188.77 | $2,982.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,722.20 / $1,722.20 / $1,722.20
| Facility | | $1,722.20 | $1,722.20 | $1,722.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.09 / $2,570.12 / $4,025.15
| Professional | | $1,977.09 | $2,570.12 | $4,025.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $33,760.48
| Facility | | $55.00 | $55.00 | $33,760.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13,242.08 / $13,540.88 / $16,230.45
| Professional | | $13,242.08 | $13,540.88 | $16,230.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.09 / $2,414.80 / $4,277.80
| Facility | | $1,971.09 | $2,414.80 | $4,277.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,385.53 / $2,752.53 / $3,211.29
| Professional | | $2,385.53 | $2,752.53 | $3,211.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,165.71 / $2,278.64 / $2,799.00
| Professional | | $2,165.71 | $2,278.64 | $2,799.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.09 / $2,570.21 / $4,820.81
| Facility | | $1,971.09 | $2,570.21 | $4,820.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.09 / $2,630.73 / $4,499.46
| Professional | | $1,977.09 | $2,630.73 | $4,499.46 |
- 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
- $1,617.97 / $2,138.39 / $3,396.82
| Professional | | $1,617.97 | $2,138.39 | $3,396.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,566.13 / $1,798.33 / $2,448.05
| Professional | | $1,566.13 | $1,798.33 | $2,448.05 |