- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $12,281.00
| Facility | | $969.00 | $3,682.00 | $12,281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,032.42 / $2,433.89 / $3,828.48
| Professional | | $2,032.42 | $2,433.89 | $3,828.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,244.39 / $3,258.37 / $5,456.77
| Professional | | $2,244.39 | $3,258.37 | $5,456.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,122.41 / $2,156.46
| Facility | | $80.00 | $2,122.41 | $2,156.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,718.09 / $2,718.09 / $2,718.09
| Facility | | $2,718.09 | $2,718.09 | $2,718.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,242.42 / $3,151.78 / $4,672.54
| Professional | | $2,242.42 | $3,151.78 | $4,672.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $33,109.68
| Facility | | $55.00 | $55.00 | $33,109.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,636.00 / $18,636.00 / $20,577.45
| Professional | | $18,636.00 | $18,636.00 | $20,577.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,241.81 / $2,819.62 / $4,687.50
| Facility | | $2,241.81 | $2,819.62 | $4,687.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,954.45 / $3,545.34 / $4,396.22
| Professional | | $2,954.45 | $3,545.34 | $4,396.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,437.50 / $2,437.50 / $2,437.50
| Professional | | $2,437.50 | $2,437.50 | $2,437.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,252.85 / $2,841.06 / $4,843.75
| Facility | | $2,252.85 | $2,841.06 | $4,843.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,288.19 / $3,280.32 / $4,906.10
| Professional | | $2,288.19 | $3,280.32 | $4,906.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,093.00 / $6,000.00 / $13,134.00
| Facility | | $2,093.00 | $6,000.00 | $13,134.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,851.58 / $2,566.69 / $3,998.39
| Professional | | $1,851.58 | $2,566.69 | $3,998.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,017.23 / $2,291.94 / $3,183.61
| Professional | | $2,017.23 | $2,291.94 | $3,183.61 |