- 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
- $2,315.92 / $2,738.56 / $4,211.77
| Professional | | $2,315.92 | $2,738.56 | $4,211.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,331.32 / $3,668.16 / $5,693.07
| Professional | | $2,331.32 | $3,668.16 | $5,693.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.19 / $2,648.19 / $2,648.19
| Facility | | $2,648.19 | $2,648.19 | $2,648.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,007.46 / $3,940.03 / $5,731.57
| Professional | | $3,007.46 | $3,940.03 | $5,731.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $50,994.56
| Facility | | $55.00 | $55.00 | $50,994.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,854.24 / $20,038.56 / $25,532.40
| Professional | | $19,854.24 | $20,038.56 | $25,532.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,694.69 / $3,613.80 / $6,421.67
| Facility | | $2,694.69 | $3,613.80 | $6,421.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,083.82 / $4,289.31 / $5,046.25
| Professional | | $3,083.82 | $4,289.31 | $5,046.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,726.20 / $3,726.20 / $3,726.20
| Professional | | $3,726.20 | $3,726.20 | $3,726.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,694.69 / $3,697.53 / $6,573.13
| Facility | | $2,694.69 | $3,697.53 | $6,573.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,023.23 / $3,949.63 / $5,878.29
| Professional | | $3,023.23 | $3,949.63 | $5,878.29 |
- 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
- $2,376.71 / $3,267.99 / $5,050.53
| Professional | | $2,376.71 | $3,267.99 | $5,050.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,392.67 / $2,717.27 / $3,721.21
| Professional | | $2,392.67 | $2,717.27 | $3,721.21 |