- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,760.00 / $2,054.77 / $4,109.38
| Facility | | $1,760.00 | $2,054.77 | $4,109.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,760.00 / $2,054.77 / $4,011.06
| Professional | | $1,760.00 | $2,054.77 | $4,011.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,188.39 / $2,932.26 / $4,267.37
| Professional | | $2,188.39 | $2,932.26 | $4,267.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,434.94 / $2,434.94 / $2,434.94
| Facility | | $2,434.94 | $2,434.94 | $2,434.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,380.17 / $3,096.83 / $4,671.81
| Professional | | $2,380.17 | $3,096.83 | $4,671.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $24,316.40
| Facility | | $55.00 | $55.00 | $24,316.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,919.91 / $19,519.36 / $23,602.65
| Professional | | $18,919.91 | $19,519.36 | $23,602.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $2,825.20 / $4,995.58
| Facility | | $2,100.00 | $2,825.20 | $4,995.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,908.76 / $4,045.82 / $4,759.79
| Professional | | $2,908.76 | $4,045.82 | $4,759.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,416.70 / $3,416.70 / $3,416.70
| Professional | | $3,416.70 | $3,416.70 | $3,416.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,100.00 / $2,843.52 / $5,176.34
| Facility | | $2,100.00 | $2,843.52 | $5,176.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,409.90 / $3,169.39 / $4,889.83
| Professional | | $2,409.90 | $3,169.39 | $4,889.83 |
- 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
- $1,870.88 / $2,619.23 / $3,984.48
| Professional | | $1,870.88 | $2,619.23 | $3,984.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,256.86 / $2,568.36 / $3,530.61
| Professional | | $2,256.86 | $2,568.36 | $3,530.61 |