- 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
- $2,598.41 / $3,072.81 / $4,723.27
| Professional | | $2,598.41 | $3,072.81 | $4,723.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,614.46 / $3,464.87 / $6,020.12
| Professional | | $2,614.46 | $3,464.87 | $6,020.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,974.27 / $2,974.27 / $2,974.27
| Facility | | $2,974.27 | $2,974.27 | $2,974.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,363.65 / $4,418.54 / $6,427.18
| Professional | | $3,363.65 | $4,418.54 | $6,427.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $42,906.96
| Facility | | $55.00 | $55.00 | $42,906.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22,224.30 / $22,483.36 / $28,630.65
| Professional | | $22,224.30 | $22,483.36 | $28,630.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.87 / $4,014.50 / $7,200.20
| Facility | | $3,025.87 | $4,014.50 | $7,200.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,458.84 / $4,810.93 / $5,659.92
| Professional | | $3,458.84 | $4,810.93 | $5,659.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,019.20 / $4,019.20 / $4,019.20
| Professional | | $4,019.20 | $4,019.20 | $4,019.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,025.87 / $4,027.83 / $7,370.01
| Facility | | $3,025.87 | $4,027.83 | $7,370.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,389.60 / $4,418.54 / $6,572.59
| Professional | | $3,389.60 | $4,418.54 | $6,572.59 |
- 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
- $2,662.39 / $3,664.57 / $5,903.29
| Professional | | $2,662.39 | $3,664.57 | $5,903.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,683.65 / $3,047.27 / $4,174.35
| Professional | | $2,683.65 | $3,047.27 | $4,174.35 |