- 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
- $2,616.58 / $2,998.79 / $3,584.05
| Professional | | $2,616.58 | $2,998.79 | $3,584.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,413.81 / $3,076.28 / $4,454.13
| Professional | | $2,413.81 | $3,076.28 | $4,454.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,486.75 / $2,486.75 / $2,486.75
| Facility | | $2,486.75 | $2,486.75 | $2,486.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,736.81 / $3,605.37 / $5,669.11
| Professional | | $2,736.81 | $3,605.37 | $5,669.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $56,348.68
| Facility | | $55.00 | $55.00 | $56,348.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,739.00 / $25,739.00 / $25,739.00
| Professional | | $25,739.00 | $25,739.00 | $25,739.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,617.26 / $3,279.50 / $6,035.07
| Facility | | $2,617.26 | $3,279.50 | $6,035.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,338.39 / $3,851.99 / $4,493.97
| Professional | | $3,338.39 | $3,851.99 | $4,493.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,475.01 / $2,743.11 / $4,453.47
| Professional | | $2,475.01 | $2,743.11 | $4,453.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,617.26 / $3,288.25 / $6,776.42
| Facility | | $2,617.26 | $3,288.25 | $6,776.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,743.11 / $3,712.47 / $6,195.85
| Professional | | $2,743.11 | $3,712.47 | $6,195.85 |
- 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
- $2,263.83 / $2,971.28 / $4,728.60
| Professional | | $2,263.83 | $2,971.28 | $4,728.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,191.69 / $2,511.21 / $3,435.03
| Professional | | $2,191.69 | $2,511.21 | $3,435.03 |