- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $10,836.00
| Facility | | $969.00 | $3,682.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,574.02 / $3,085.53 / $4,083.65
| Professional | | $2,574.02 | $3,085.53 | $4,083.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,582.75 / $3,269.13 / $3,724.77
| Professional | | $2,582.75 | $3,269.13 | $3,724.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,380.07 / $2,380.07 / $2,380.07
| Facility | | $2,380.07 | $2,380.07 | $2,380.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,769.46 / $3,745.42 / $5,782.10
| Professional | | $2,769.46 | $3,745.42 | $5,782.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $34,913.23
| Facility | | $55.00 | $55.00 | $34,913.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $20,145.43 / $20,744.16 / $23,378.63
| Professional | | $20,145.43 | $20,744.16 | $23,378.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,633.47 / $3,374.89 / $6,261.21
| Facility | | $2,633.47 | $3,374.89 | $6,261.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,979.92 / $4,144.80 / $4,876.24
| Professional | | $2,979.92 | $4,144.80 | $4,876.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,087.70 / $3,087.70 / $3,087.70
| Professional | | $3,087.70 | $3,087.70 | $3,087.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,633.47 / $3,423.51 / $6,724.32
| Facility | | $2,633.47 | $3,423.51 | $6,724.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,812.91 / $3,778.20 / $5,942.68
| Professional | | $2,812.91 | $3,778.20 | $5,942.68 |
- 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
- $2,259.60 / $3,218.75 / $4,974.43
| Professional | | $2,259.60 | $3,218.75 | $4,974.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,312.07 / $2,633.47 / $3,655.34
| Professional | | $2,312.07 | $2,633.47 | $3,655.34 |