- 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
- $2,164.85 / $2,558.86 / $3,939.96
| Professional | | $2,164.85 | $2,558.86 | $3,939.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,181.58 / $3,453.76 / $5,360.32
| Professional | | $2,181.58 | $3,453.76 | $5,360.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,467.19 / $2,467.19 / $2,467.19
| Facility | | $2,467.19 | $2,467.19 | $2,467.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,758.29 / $3,604.99 / $5,344.51
| Professional | | $2,758.29 | $3,604.99 | $5,344.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $35,749.92
| Facility | | $55.00 | $55.00 | $35,749.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $18,623.70 / $18,732.72 / $23,886.98
| Professional | | $18,623.70 | $18,732.72 | $23,886.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,322.63 / $3,092.45 / $6,023.60
| Facility | | $2,322.63 | $3,092.45 | $6,023.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,883.85 / $4,011.17 / $4,719.02
| Professional | | $2,883.85 | $4,011.17 | $4,719.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,707.80 / $2,707.80 / $2,707.80
| Professional | | $2,707.80 | $2,707.80 | $2,707.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,351.75 / $3,126.53 / $6,144.71
| Facility | | $2,351.75 | $3,126.53 | $6,144.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,771.17 / $3,677.09 / $5,522.67
| Professional | | $2,771.17 | $3,677.09 | $5,522.67 |
- 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
- $2,116.57 / $2,922.77 / $4,630.78
| Professional | | $2,116.57 | $2,922.77 | $4,630.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,237.53 / $2,541.91 / $3,478.92
| Professional | | $2,237.53 | $2,541.91 | $3,478.92 |