- 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
- $2,201.08 / $2,524.31 / $3,016.45
| Professional | | $2,201.08 | $2,524.31 | $3,016.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,054.26 / $2,600.19 / $3,622.65
| Professional | | $2,054.26 | $2,600.19 | $3,622.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,065.35 / $2,065.35 / $2,065.35
| Facility | | $2,065.35 | $2,065.35 | $2,065.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,325.69 / $3,033.13 / $4,740.83
| Professional | | $2,325.69 | $3,033.13 | $4,740.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $65,008.58
| Facility | | $55.00 | $55.00 | $65,008.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,267.00 / $23,267.00 / $23,267.00
| Professional | | $23,267.00 | $23,267.00 | $23,267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,325.69 / $2,873.04 / $5,326.15
| Facility | | $2,325.69 | $2,873.04 | $5,326.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,820.74 / $3,254.70 / $3,797.15
| Professional | | $2,820.74 | $3,254.70 | $3,797.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,535.80 / $3,535.80 / $3,535.80
| Professional | | $3,535.80 | $3,535.80 | $3,535.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,325.69 / $3,009.10 / $5,726.96
| Facility | | $2,325.69 | $3,009.10 | $5,726.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,325.69 / $3,145.80 / $4,749.06
| Professional | | $2,325.69 | $3,145.80 | $4,749.06 |
- 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
- $1,905.53 / $2,501.01 / $4,000.54
| Professional | | $1,905.53 | $2,501.01 | $4,000.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,851.86 / $2,121.31 / $2,898.92
| Professional | | $1,851.86 | $2,121.31 | $2,898.92 |