- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,682.00 / $10,893.00
| Facility | | $945.00 | $3,682.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,757.47 / $3,102.78 / $4,573.00
| Professional | | $2,757.47 | $3,102.78 | $4,573.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,705.87 / $3,424.97 / $4,771.76
| Professional | | $2,705.87 | $3,424.97 | $4,771.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,730.14 / $2,730.14 / $2,846.07
| Facility | | $2,730.14 | $2,730.14 | $2,846.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $2,277.00 / $4,619.00
| Facility | | $900.00 | $2,277.00 | $4,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,239.00 / $3,908.48 / $6,109.67
| Professional | | $2,239.00 | $3,908.48 | $6,109.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $27,115.76
| Facility | | $55.00 | $55.00 | $27,115.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,233.36 / $21,746.64 / $26,008.28
| Professional | | $21,233.36 | $21,746.64 | $26,008.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,989.78 / $3,191.68 / $6,141.08
| Facility | | $1,989.78 | $3,191.68 | $6,141.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,380.60 / $4,497.66 / $5,291.37
| Professional | | $3,380.60 | $4,497.66 | $5,291.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $3,803.23 / $7,584.90
| Professional | | $7.00 | $3,803.23 | $7,584.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,989.78 / $3,204.75 / $6,742.68
| Facility | | $1,989.78 | $3,204.75 | $6,742.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,536.07 / $4,188.25 / $7,402.92
| Professional | | $2,536.07 | $4,188.25 | $7,402.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,392.86 / $3,211.47 / $5,168.10
| Professional | | $2,392.86 | $3,211.47 | $5,168.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,508.90 / $2,914.45 / $3,929.99
| Professional | | $2,508.90 | $2,914.45 | $3,929.99 |