- 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
- $2,328.91 / $2,686.99 / $3,223.98
| Professional | | $2,328.91 | $2,686.99 | $3,223.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,190.00 / $2,722.20 / $3,862.02
| Professional | | $2,190.00 | $2,722.20 | $3,862.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,176.63 / $2,176.63 / $2,176.63
| Facility | | $2,176.63 | $2,176.63 | $2,176.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,499.10 / $3,281.44 / $5,087.91
| Professional | | $2,499.10 | $3,281.44 | $5,087.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $42,560.96
| Facility | | $55.00 | $55.00 | $42,560.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24,892.75 / $24,892.75 / $24,892.75
| Professional | | $24,892.75 | $24,892.75 | $24,892.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,384.71 / $3,057.40 / $5,533.79
| Facility | | $2,384.71 | $3,057.40 | $5,533.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,009.55 / $3,472.56 / $4,051.32
| Professional | | $3,009.55 | $3,472.56 | $4,051.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,525.88 / $3,952.85 / $8,641.23
| Professional | | $2,525.88 | $3,952.85 | $8,641.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,384.71 / $3,126.61 / $6,610.38
| Facility | | $2,384.71 | $3,126.61 | $6,610.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,498.26 / $3,408.46 / $5,865.14
| Professional | | $2,498.26 | $3,408.46 | $5,865.14 |
- 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
- $2,068.91 / $2,702.93 / $4,324.68
| Professional | | $2,068.91 | $2,702.93 | $4,324.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,975.82 / $2,271.15 / $3,086.83
| Professional | | $1,975.82 | $2,271.15 | $3,086.83 |