- 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
- $1,927.98 / $2,279.52 / $3,544.38
| Professional | | $1,927.98 | $2,279.52 | $3,544.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,938.73 / $3,072.17 / $4,768.08
| Professional | | $1,938.73 | $3,072.17 | $4,768.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,210.54 / $2,210.54 / $2,210.54
| Facility | | $2,210.54 | $2,210.54 | $2,210.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,508.07 / $3,276.39 / $4,768.06
| Professional | | $2,508.07 | $3,276.39 | $4,768.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $31,826.04
| Facility | | $55.00 | $55.00 | $31,826.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,482.00 / $16,675.43 / $21,227.10
| Professional | | $16,482.00 | $16,675.43 | $21,227.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,246.10 / $2,987.22 / $5,320.69
| Facility | | $2,246.10 | $2,987.22 | $5,320.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,565.05 / $3,567.75 / $4,197.35
| Professional | | $2,565.05 | $3,567.75 | $4,197.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,053.10 / $3,053.10 / $3,053.10
| Professional | | $3,053.10 | $3,053.10 | $3,053.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,246.10 / $3,016.27 / $5,446.18
| Facility | | $2,246.10 | $3,016.27 | $5,446.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,508.07 / $3,276.39 / $4,886.22
| Professional | | $2,508.07 | $3,276.39 | $4,886.22 |
- 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
- $1,949.15 / $2,706.60 / $4,187.30
| Professional | | $1,949.15 | $2,706.60 | $4,187.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,990.17 / $2,259.58 / $3,096.05
| Professional | | $1,990.17 | $2,259.58 | $3,096.05 |