- 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
- $1,931.70 / $2,130.51 / $2,946.33
| Professional | | $1,931.70 | $2,130.51 | $2,946.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,876.04 / $2,374.61 / $3,308.37
| Professional | | $1,876.04 | $2,374.61 | $3,308.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.95 / $1,924.95 / $1,924.95
| Facility | | $1,924.95 | $1,924.95 | $1,924.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,991.96 / $2,665.76 / $4,084.16
| Professional | | $1,991.96 | $2,665.76 | $4,084.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $25,550.36
| Facility | | $55.00 | $55.00 | $25,550.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,727.30 / $20,776.70 / $21,607.76
| Professional | | $17,727.30 | $20,776.70 | $21,607.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,803.40 / $2,347.78 / $4,439.77
| Facility | | $1,803.40 | $2,347.78 | $4,439.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,207.81 / $3,070.86 / $3,612.78
| Professional | | $2,207.81 | $3,070.86 | $3,612.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,874.90 / $1,874.90 / $1,874.90
| Professional | | $1,874.90 | $1,874.90 | $1,874.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,803.40 / $2,419.92 / $4,544.47
| Facility | | $1,803.40 | $2,419.92 | $4,544.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.33 / $2,686.24 / $4,208.24
| Professional | | $2,053.33 | $2,686.24 | $4,208.24 |
- 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
- $1,581.75 / $2,215.67 / $3,488.09
| Professional | | $1,581.75 | $2,215.67 | $3,488.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,713.00 / $1,947.54 / $2,690.21
| Professional | | $1,713.00 | $1,947.54 | $2,690.21 |