- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,682.00 / $10,893.00
| Facility | | $969.00 | $3,682.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,571.07 / $2,939.88 / $4,319.71
| Professional | | $2,571.07 | $2,939.88 | $4,319.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,695.71 / $3,412.12 / $4,753.84
| Professional | | $2,695.71 | $3,412.12 | $4,753.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,620.75 / $2,620.75 / $2,620.75
| Facility | | $2,620.75 | $2,620.75 | $2,620.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,914.95 / $3,896.00 / $5,959.95
| Professional | | $2,914.95 | $3,896.00 | $5,959.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $30,019.59
| Facility | | $55.00 | $55.00 | $30,019.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21,127.92 / $21,615.68 / $24,805.05
| Professional | | $21,127.92 | $21,615.68 | $24,805.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,721.33 / $3,418.61 / $6,480.50
| Facility | | $2,721.33 | $3,418.61 | $6,480.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,145.37 / $4,374.93 / $5,146.97
| Professional | | $3,145.37 | $4,374.93 | $5,146.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,350.80 / $3,350.80 / $3,350.80
| Professional | | $3,350.80 | $3,350.80 | $3,350.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,748.91 / $3,533.00 / $6,633.34
| Facility | | $2,748.91 | $3,533.00 | $6,633.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,914.95 / $4,028.95 / $6,145.20
| Professional | | $2,914.95 | $4,028.95 | $6,145.20 |
- 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
- $2,292.63 / $3,175.90 / $5,002.08
| Professional | | $2,292.63 | $3,175.90 | $5,002.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,440.44 / $2,786.91 / $3,847.73
| Professional | | $2,440.44 | $2,786.91 | $3,847.73 |