- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.00 / $3,682.00 / $12,480.00
| Facility | | $1,086.00 | $3,682.00 | $12,480.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,328.77 / $2,770.59 / $4,351.87
| Professional | | $2,328.77 | $2,770.59 | $4,351.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,503.38 / $2,913.65 / $4,245.18
| Professional | | $2,503.38 | $2,913.65 | $4,245.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,400.39 / $2,464.27
| Facility | | $80.00 | $2,400.39 | $2,464.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,106.91 / $3,106.91 / $3,106.91
| Facility | | $3,106.91 | $3,106.91 | $3,106.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,547.05 / $3,526.38 / $5,214.12
| Professional | | $2,547.05 | $3,526.38 | $5,214.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $28,073.34
| Facility | | $55.00 | $55.00 | $28,073.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,658.64 / $20,077.91 / $23,441.70
| Professional | | $19,658.64 | $20,077.91 | $23,441.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,510.73 / $3,123.89 / $5,016.26
| Facility | | $2,510.73 | $3,123.89 | $5,016.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,352.31 / $4,022.78 / $4,988.24
| Professional | | $3,352.31 | $4,022.78 | $4,988.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,296.70 / $3,296.70 / $3,296.70
| Professional | | $3,296.70 | $3,296.70 | $3,296.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,516.12 / $3,128.47 / $5,299.99
| Facility | | $2,516.12 | $3,128.47 | $5,299.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,593.19 / $3,679.39 / $5,629.94
| Professional | | $2,593.19 | $3,679.39 | $5,629.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,600.00 / $7,123.00 / $16,000.00
| Facility | | $2,600.00 | $7,123.00 | $16,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,154.40 / $2,873.45 / $4,538.38
| Professional | | $2,154.40 | $2,873.45 | $4,538.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,288.88 / $2,607.06 / $3,603.95
| Professional | | $2,288.88 | $2,607.06 | $3,603.95 |