- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,596.00 / $10,893.00
| Facility | | $969.00 | $3,596.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,102.03 / $2,490.52 / $3,892.95
| Professional | | $2,102.03 | $2,490.52 | $3,892.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,115.42 / $3,318.77 / $5,150.81
| Professional | | $2,115.42 | $3,318.77 | $5,150.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,403.65 / $2,403.65 / $2,403.65
| Facility | | $2,403.65 | $2,403.65 | $2,403.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,720.43 / $3,575.28 / $5,201.55
| Professional | | $2,720.43 | $3,575.28 | $5,201.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $34,707.83
| Facility | | $55.00 | $55.00 | $34,707.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,001.25 / $18,185.04 / $23,169.60
| Professional | | $18,001.25 | $18,185.04 | $23,169.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,445.94 / $3,255.00 / $5,816.56
| Facility | | $2,445.94 | $3,255.00 | $5,816.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,798.46 / $3,892.40 / $4,579.29
| Professional | | $2,798.46 | $3,892.40 | $4,579.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,276.60 / $3,276.60 / $3,276.60
| Professional | | $3,276.60 | $3,276.60 | $3,276.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,445.94 / $3,258.58 / $5,953.74
| Facility | | $2,445.94 | $3,258.58 | $5,953.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,740.57 / $3,575.28 / $5,336.39
| Professional | | $2,740.57 | $3,575.28 | $5,336.39 |
- 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
- $2,151.80 / $2,880.84 / $4,576.88
| Professional | | $2,151.80 | $2,880.84 | $4,576.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,171.27 / $2,465.71 / $3,376.94
| Professional | | $2,171.27 | $2,465.71 | $3,376.94 |