- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $12,941.00
| Facility | | $969.00 | $3,682.00 | $12,941.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,008.28 / $3,576.14 / $4,790.30
| Professional | | $3,008.28 | $3,576.14 | $4,790.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,897.94 / $3,668.08 / $5,110.46
| Professional | | $2,897.94 | $3,668.08 | $5,110.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,953.91 / $2,953.91 / $2,953.91
| Facility | | $2,953.91 | $2,953.91 | $2,953.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,262.22 / $4,243.10 / $6,743.72
| Professional | | $3,262.22 | $4,243.10 | $6,743.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $74,218.62
| Facility | | $55.00 | $55.00 | $74,218.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,634.00 / $26,634.00 / $26,924.40
| Professional | | $26,634.00 | $26,634.00 | $26,924.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,118.70 / $3,912.06 / $7,207.09
| Facility | | $3,118.70 | $3,912.06 | $7,207.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,978.82 / $4,590.95 / $5,356.10
| Professional | | $3,978.82 | $4,590.95 | $5,356.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,939.25 / $3,270.77 / $5,309.09
| Professional | | $2,939.25 | $3,270.77 | $5,309.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,118.70 / $3,916.01 / $8,079.01
| Facility | | $3,118.70 | $3,916.01 | $8,079.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,270.77 / $4,342.66 / $7,314.38
| Professional | | $3,270.77 | $4,342.66 | $7,314.38 |
- 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
- $2,681.89 / $3,540.98 / $5,674.71
| Professional | | $2,681.89 | $3,540.98 | $5,674.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,612.16 / $2,993.94 / $4,093.56
| Professional | | $2,612.16 | $2,993.94 | $4,093.56 |