- 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
- $3,248.16 / $3,753.13 / $4,514.09
| Professional | | $3,248.16 | $3,753.13 | $4,514.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,058.92 / $3,871.85 / $5,276.08
| Professional | | $3,058.92 | $3,871.85 | $5,276.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,105.19 / $3,105.19 / $3,105.19
| Facility | | $3,105.19 | $3,105.19 | $3,105.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,453.55 / $4,561.68 / $7,172.07
| Professional | | $3,453.55 | $4,561.68 | $7,172.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $96,906.94
| Facility | | $55.00 | $55.00 | $96,906.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23,452.08 / $24,013.92 / $28,408.28
| Professional | | $23,452.08 | $24,013.92 | $28,408.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,199.77 / $3,798.91 / $7,589.85
| Facility | | $3,199.77 | $3,798.91 | $7,589.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,197.47 / $4,843.25 / $5,650.45
| Professional | | $4,197.47 | $4,843.25 | $5,650.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,089.78 / $3,453.55 / $5,601.73
| Professional | | $3,089.78 | $3,453.55 | $5,601.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,199.77 / $3,816.17 / $8,527.79
| Facility | | $3,199.77 | $3,816.17 | $8,527.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,453.55 / $4,738.85 / $7,838.49
| Professional | | $3,453.55 | $4,738.85 | $7,838.49 |
- 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
- $2,691.56 / $3,629.70 / $5,867.97
| Professional | | $2,691.56 | $3,629.70 | $5,867.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,755.71 / $3,159.89 / $4,317.50
| Professional | | $2,755.71 | $3,159.89 | $4,317.50 |