- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,637.97 / $10,836.00
| Facility | | $969.00 | $3,637.97 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,284.86 / $2,621.83 / $3,133.43
| Professional | | $2,284.86 | $2,621.83 | $3,133.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,133.98 / $2,701.10 / $3,763.23
| Professional | | $2,133.98 | $2,701.10 | $3,763.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,141.88 / $2,141.88 / $2,141.88
| Facility | | $2,141.88 | $2,141.88 | $2,141.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,417.98 / $3,248.68 / $5,176.87
| Professional | | $2,417.98 | $3,248.68 | $5,176.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $67,531.88
| Facility | | $55.00 | $55.00 | $67,531.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30,682.00 / $32,890.94 / $32,890.94
| Professional | | $30,682.00 | $32,890.94 | $32,890.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,417.98 / $3,102.89 / $6,485.35
| Facility | | $2,417.98 | $3,102.89 | $6,485.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,930.92 / $3,381.83 / $3,945.46
| Professional | | $2,930.92 | $3,381.83 | $3,945.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,679.30 / $3,679.30 / $3,679.30
| Professional | | $3,679.30 | $3,679.30 | $3,679.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,417.98 / $3,138.68 / $6,485.35
| Facility | | $2,417.98 | $3,138.68 | $6,485.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,417.98 / $3,300.76 / $5,194.35
| Professional | | $2,417.98 | $3,300.76 | $5,194.35 |
- 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
- $1,981.46 / $2,600.67 / $4,146.68
| Professional | | $1,981.46 | $2,600.67 | $4,146.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,924.19 / $2,204.83 / $3,011.65
| Professional | | $1,924.19 | $2,204.83 | $3,011.65 |