- 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
- $2,526.98 / $2,895.97 / $3,461.26
| Professional | | $2,526.98 | $2,895.97 | $3,461.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,348.21 / $2,972.26 / $4,141.02
| Professional | | $2,348.21 | $2,972.26 | $4,141.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,401.39 / $2,401.39 / $2,401.39
| Facility | | $2,401.39 | $2,401.39 | $2,401.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,644.37 / $3,469.95 / $5,462.96
| Professional | | $2,644.37 | $3,469.95 | $5,462.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $54,441.65
| Facility | | $55.00 | $55.00 | $54,441.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,438.00 / $23,438.00 / $23,438.00
| Professional | | $23,438.00 | $23,438.00 | $23,438.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,547.46 / $3,183.14 / $5,789.04
| Facility | | $2,547.46 | $3,183.14 | $5,789.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,225.27 / $3,721.47 / $4,341.72
| Professional | | $3,225.27 | $3,721.47 | $4,341.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,389.77 / $2,649.99 / $4,302.72
| Professional | | $2,389.77 | $2,649.99 | $4,302.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,547.46 / $3,195.80 / $6,544.73
| Facility | | $2,547.46 | $3,195.80 | $6,544.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,649.99 / $3,569.50 / $5,958.00
| Professional | | $2,649.99 | $3,569.50 | $5,958.00 |
- 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
- $2,179.77 / $2,867.21 / $4,630.78
| Professional | | $2,179.77 | $2,867.21 | $4,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,117.44 / $2,426.15 / $3,318.72
| Professional | | $2,117.44 | $2,426.15 | $3,318.72 |