- 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
- $1,777.14 / $2,029.32 / $3,304.40
| Professional | | $1,777.14 | $2,029.32 | $3,304.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,786.26 / $2,375.73 / $3,561.31
| Professional | | $1,786.26 | $2,375.73 | $3,561.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,044.37 / $2,044.37 / $2,044.37
| Facility | | $2,044.37 | $2,044.37 | $2,044.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,281.01 / $2,963.94 / $4,392.43
| Professional | | $2,281.01 | $2,963.94 | $4,392.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $29,352.24
| Facility | | $55.00 | $55.00 | $29,352.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,668.47 / $17,668.47 / $19,568.70
| Professional | | $17,668.47 | $17,668.47 | $19,568.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,071.11 / $2,754.54 / $4,892.07
| Facility | | $2,071.11 | $2,754.54 | $4,892.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,365.08 / $3,289.61 / $3,870.13
| Professional | | $2,365.08 | $3,289.61 | $3,870.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,752.60 / $2,752.60 / $2,752.60
| Professional | | $2,752.60 | $2,752.60 | $2,752.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,071.11 / $2,757.95 / $5,044.22
| Facility | | $2,071.11 | $2,757.95 | $5,044.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,307.98 / $3,019.84 / $4,496.74
| Professional | | $2,307.98 | $3,019.84 | $4,496.74 |
- 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
- $1,755.25 / $2,445.15 / $3,852.32
| Professional | | $1,755.25 | $2,445.15 | $3,852.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.02 / $2,082.92 / $2,855.16
| Professional | | $1,835.02 | $2,082.92 | $2,855.16 |