- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,391.98 / $15,066.80 / $41,514.00
| Facility | | $6,391.98 | $15,066.80 | $41,514.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,607.97 / $5,073.00 / $6,848.55
| Professional | | $4,607.97 | $5,073.00 | $6,848.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,455.00 / $8,455.00 / $8,455.00
| Professional | | $8,455.00 | $8,455.00 | $8,455.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,918.50 / $7,609.50 / $8,674.78
| Professional | | $5,918.50 | $7,609.50 | $8,674.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $80.00 / $80.00
| Facility | | $80.00 | $80.00 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,495.75 / $19,843.50 / $37,670.60
| Facility | | $5,495.75 | $19,843.50 | $37,670.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,298.34 / $10,298.34 / $12,338.57
| Professional | | $10,298.34 | $10,298.34 | $12,338.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,528.00 / $40,161.25 / $40,161.25
| Facility | | $13,528.00 | $40,161.25 | $40,161.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $42,105.90 / $42,105.90 / $63,412.50
| Professional | | $42,105.90 | $42,105.90 | $63,412.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,073.00 / $8,455.00 / $12,375.41
| Facility | | $5,073.00 | $8,455.00 | $12,375.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,455.00 / $8,455.00 / $10,568.75
| Professional | | $8,455.00 | $8,455.00 | $10,568.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,661.86 / $8,705.27 / $30,450.63
| Facility | | $5,661.86 | $8,705.27 | $30,450.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,990.02 / $10,230.54 / $14,796.25
| Professional | | $7,990.02 | $10,230.54 | $14,796.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,543.50 / $1,543.50 / $3,212.90
| Professional | | $1,543.50 | $1,543.50 | $3,212.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $1,433.25 / $8,455.00
| Professional | | $208.00 | $1,433.25 | $8,455.00 |