- 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
- $2,277.69 / $2,615.51 / $3,999.63
| Professional | | $2,277.69 | $2,615.51 | $3,999.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,621.23 / $3,319.43 / $4,622.49
| Professional | | $2,621.23 | $3,319.43 | $4,622.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,724.94 / $2,724.94 / $2,724.94
| Facility | | $2,724.94 | $2,724.94 | $2,724.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,796.01 / $3,629.65 / $5,145.16
| Professional | | $2,796.01 | $3,629.65 | $5,145.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $37,836.12
| Facility | | $55.00 | $55.00 | $37,836.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,414.88 / $19,981.91 / $25,006.65
| Professional | | $19,414.88 | $19,981.91 | $25,006.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,524.46 / $3,199.70 / $6,279.03
| Facility | | $2,524.46 | $3,199.70 | $6,279.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,035.78 / $4,222.49 / $4,967.64
| Professional | | $3,035.78 | $4,222.49 | $4,967.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,022.10 / $3,022.10 / $3,022.10
| Professional | | $3,022.10 | $3,022.10 | $3,022.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,527.89 / $3,206.72 / $6,439.39
| Facility | | $2,527.89 | $3,206.72 | $6,439.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,796.01 / $3,674.04 / $5,746.11
| Professional | | $2,796.01 | $3,674.04 | $5,746.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $2,547.00 / $9,000.00
| Facility | | $495.00 | $2,547.00 | $9,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,053.86 / $2,934.08 / $4,987.93
| Professional | | $2,053.86 | $2,934.08 | $4,987.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,355.41 / $2,666.42 / $3,674.55
| Professional | | $2,355.41 | $2,666.42 | $3,674.55 |