- 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
- $2,960.46 / $3,499.52 / $5,528.04
| Professional | | $2,960.46 | $3,499.52 | $5,528.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,885.00 / $4,089.62 / $7,449.95
| Professional | | $2,885.00 | $4,089.62 | $7,449.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,362.70 / $3,362.70 / $3,362.70
| Facility | | $3,362.70 | $3,362.70 | $3,362.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,892.62 / $5,045.97 / $7,292.27
| Professional | | $3,892.62 | $5,045.97 | $7,292.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $65,209.92
| Facility | | $55.00 | $55.00 | $65,209.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,542.66 / $25,619.68 / $32,708.70
| Professional | | $25,542.66 | $25,619.68 | $32,708.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,319.29 / $4,583.83 / $8,313.39
| Facility | | $3,319.29 | $4,583.83 | $8,313.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,947.02 / $5,489.95 / $6,458.76
| Professional | | $3,947.02 | $5,489.95 | $6,458.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,723.20 / $4,723.20 / $4,723.20
| Professional | | $4,723.20 | $4,723.20 | $4,723.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,319.29 / $4,594.58 / $8,402.96
| Facility | | $3,319.29 | $4,594.58 | $8,402.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,897.62 / $5,075.39 / $7,408.20
| Professional | | $3,897.62 | $5,075.39 | $7,408.20 |
- 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
- $3,054.79 / $4,117.47 / $6,510.10
| Professional | | $3,054.79 | $4,117.47 | $6,510.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,062.42 / $3,479.98 / $4,760.13
| Professional | | $3,062.42 | $3,479.98 | $4,760.13 |