- 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
- $2,716.99 / $3,261.90 / $4,294.88
| Professional | | $2,716.99 | $3,261.90 | $4,294.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.72 / $3,432.38 / $3,910.76
| Professional | | $2,711.72 | $3,432.38 | $3,910.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,499.48 / $2,499.48 / $2,499.48
| Facility | | $2,499.48 | $2,499.48 | $2,499.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,946.87 / $3,969.25 / $6,138.50
| Professional | | $2,946.87 | $3,969.25 | $6,138.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $36,595.79
| Facility | | $55.00 | $55.00 | $36,595.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,109.20 / $21,757.92 / $24,511.95
| Professional | | $21,109.20 | $21,757.92 | $24,511.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,838.22 / $3,586.53 / $6,611.90
| Facility | | $2,838.22 | $3,586.53 | $6,611.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,123.32 / $4,344.25 / $5,110.88
| Professional | | $3,123.32 | $4,344.25 | $5,110.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,597.80 / $3,597.80 / $3,597.80
| Professional | | $3,597.80 | $3,597.80 | $3,597.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,832.40 / $3,682.12 / $7,215.91
| Facility | | $2,832.40 | $3,682.12 | $7,215.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,979.58 / $4,039.85 / $6,254.41
| Professional | | $2,979.58 | $4,039.85 | $6,254.41 |
- 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
- $2,421.30 / $3,251.46 / $5,217.16
| Professional | | $2,421.30 | $3,251.46 | $5,217.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,423.33 / $2,758.87 / $3,831.60
| Professional | | $2,423.33 | $2,758.87 | $3,831.60 |