- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,747.00 / $5,454.00
| Facility | | $2,663.12 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,539.21 / $2,815.58 / $4,762.83
| Professional | | $2,539.21 | $2,815.58 | $4,762.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.00 / $6,451.79 / $20,362.00
| Facility | | $2,485.00 | $6,451.79 | $20,362.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,623.79 / $4,569.38 / $19,493.34
| Professional | | $2,623.79 | $4,569.38 | $19,493.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,839.18 / $17,839.18 / $17,839.18
| Professional | | $17,839.18 | $17,839.18 | $17,839.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $3,000.00
| Facility | | $2,000.00 | $2,000.00 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,112.31 / $4,432.08 / $7,516.94
| Professional | | $3,112.31 | $4,432.08 | $7,516.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,803.48 / $8,090.00
| Facility | | $300.00 | $3,803.48 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,119.57 / $3,778.83 / $5,149.32
| Professional | | $3,119.57 | $3,778.83 | $5,149.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,485.70 / $6,595.29 / $8,773.51
| Professional | | $3,485.70 | $6,595.29 | $8,773.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.75 / $884.75 / $884.75
| Professional | | $884.75 | $884.75 | $884.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.00 / $6,238.00 / $29,154.07
| Facility | | $2,485.00 | $6,238.00 | $29,154.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,915.32 / $5,010.22 / $19,493.34
| Professional | | $2,915.32 | $5,010.22 | $19,493.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.00 / $6,474.00 / $13,737.00
| Facility | | $2,485.00 | $6,474.00 | $13,737.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,739.28 / $4,074.85 / $8,443.98
| Professional | | $2,739.28 | $4,074.85 | $8,443.98 |