- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $12,281.00
| Facility | | $969.00 | $3,682.00 | $12,281.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,407.09 / $2,810.70 / $3,369.47
| Professional | | $2,407.09 | $2,810.70 | $3,369.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,292.19 / $2,901.35 / $4,042.23
| Professional | | $2,292.19 | $2,901.35 | $4,042.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,269.17 / $2,269.17 / $2,269.17
| Facility | | $2,269.17 | $2,269.17 | $2,269.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,597.19 / $3,396.91 / $5,397.13
| Professional | | $2,597.19 | $3,396.91 | $5,397.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $58,376.64
| Facility | | $55.00 | $55.00 | $58,376.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,450.80 / $17,921.43 / $21,344.18
| Professional | | $17,450.80 | $17,921.43 | $21,344.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,388.23 / $2,856.91 / $5,674.43
| Facility | | $2,388.23 | $2,856.91 | $5,674.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,139.90 / $3,622.97 / $4,226.79
| Professional | | $3,139.90 | $3,622.97 | $4,226.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,179.70 / $3,179.70 / $3,179.70
| Professional | | $3,179.70 | $3,179.70 | $3,179.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,388.23 / $2,869.89 / $6,390.27
| Facility | | $2,388.23 | $2,869.89 | $6,390.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,597.19 / $3,522.14 / $5,919.25
| Professional | | $2,597.19 | $3,522.14 | $5,919.25 |
- 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
- $2,114.73 / $2,810.45 / $4,489.10
| Professional | | $2,114.73 | $2,810.45 | $4,489.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,061.39 / $2,365.39 / $3,224.11
| Professional | | $2,061.39 | $2,365.39 | $3,224.11 |