- 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
- $2,759.14 / $3,027.47 / $4,177.47
| Professional | | $2,759.14 | $3,027.47 | $4,177.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,659.39 / $3,366.14 / $4,689.79
| Professional | | $2,659.39 | $3,366.14 | $4,689.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,728.83 / $2,728.83 / $2,728.83
| Facility | | $2,728.83 | $2,728.83 | $2,728.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,288.87 / $3,288.87 / $6,762.81
| Professional | | $3,288.87 | $3,288.87 | $6,762.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $36,162.72
| Facility | | $55.00 | $55.00 | $36,162.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,050.75 / $30,904.28 / $32,140.45
| Professional | | $25,050.75 | $30,904.28 | $32,140.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,763.12 / $3,519.53 / $6,342.21
| Facility | | $2,763.12 | $3,519.53 | $6,342.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,125.45 / $4,347.22 / $5,114.38
| Professional | | $3,125.45 | $4,347.22 | $5,114.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,394.60 / $3,394.60 / $3,394.60
| Professional | | $3,394.60 | $3,394.60 | $3,394.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,763.12 / $3,592.06 / $6,800.17
| Facility | | $2,763.12 | $3,592.06 | $6,800.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,763.12 / $4,934.49 / $8,136.24
| Professional | | $2,763.12 | $4,934.49 | $8,136.24 |
- 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
- $2,261.73 / $3,145.08 / $4,984.87
| Professional | | $2,261.73 | $3,145.08 | $4,984.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,424.98 / $2,763.12 / $3,806.99
| Professional | | $2,424.98 | $2,763.12 | $3,806.99 |