- 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
- $1,804.18 / $2,082.76 / $2,495.87
| Professional | | $1,804.18 | $2,082.76 | $2,495.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,695.36 / $2,146.46 / $2,989.74
| Professional | | $1,695.36 | $2,146.46 | $2,989.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,686.33 / $1,686.33 / $1,686.33
| Facility | | $1,686.33 | $1,686.33 | $1,686.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,934.63 / $2,596.69 / $4,026.78
| Professional | | $1,934.63 | $2,596.69 | $4,026.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $32,978.24
| Facility | | $55.00 | $55.00 | $32,978.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,938.16 / $13,276.16 / $15,861.83
| Professional | | $12,938.16 | $13,276.16 | $15,861.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,925.26 / $2,449.73 / $4,173.89
| Facility | | $1,925.26 | $2,449.73 | $4,173.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,331.28 / $2,689.94 / $3,138.26
| Professional | | $2,331.28 | $2,689.94 | $3,138.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,005.13 / $2,101.79 / $2,321.46
| Professional | | $2,005.13 | $2,101.79 | $2,321.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,925.26 / $2,466.90 / $4,726.41
| Facility | | $1,925.26 | $2,466.90 | $4,726.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,934.55 / $2,664.70 / $4,580.63
| Professional | | $1,934.55 | $2,664.70 | $4,580.63 |
- 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
- $1,671.78 / $2,216.88 / $3,379.70
| Professional | | $1,671.78 | $2,216.88 | $3,379.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,530.52 / $1,758.75 / $2,391.59
| Professional | | $1,530.52 | $1,758.75 | $2,391.59 |