- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,836.00
| Facility | | $969.00 | $3,596.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,242.66 / $2,573.73 / $3,076.14
| Professional | | $2,242.66 | $2,573.73 | $3,076.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,094.27 / $2,650.84 / $3,693.21
| Professional | | $2,094.27 | $2,650.84 | $3,693.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,099.58 / $2,099.58 / $2,099.58
| Facility | | $2,099.58 | $2,099.58 | $2,099.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,372.03 / $3,119.22 / $4,873.47
| Professional | | $2,372.03 | $3,119.22 | $4,873.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $66,228.24
| Facility | | $55.00 | $55.00 | $66,228.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26,421.00 / $26,421.00 / $26,421.00
| Professional | | $26,421.00 | $26,421.00 | $26,421.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.77 / $2,849.78 / $6,365.57
| Facility | | $2,321.77 | $2,849.78 | $6,365.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,874.57 / $3,316.82 / $3,869.62
| Professional | | $2,874.57 | $3,316.82 | $3,869.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,403.00 / $3,403.00 / $3,403.00
| Professional | | $3,403.00 | $3,403.00 | $3,403.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,321.77 / $2,892.90 / $6,365.57
| Facility | | $2,321.77 | $2,892.90 | $6,365.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,372.03 / $3,243.46 / $4,981.77
| Professional | | $2,372.03 | $3,243.46 | $4,981.77 |
- 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
- $1,931.02 / $2,554.44 / $4,073.10
| Professional | | $1,931.02 | $2,554.44 | $4,073.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,887.20 / $2,162.73 / $2,953.57
| Professional | | $1,887.20 | $2,162.73 | $2,953.57 |