- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,792.00 / $10,836.00
| Facility | | $969.00 | $3,792.00 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,890.42 / $4,597.77 / $5,503.71
| Professional | | $3,890.42 | $4,597.77 | $5,503.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,731.99 / $4,756.24 / $6,481.23
| Professional | | $3,731.99 | $4,756.24 | $6,481.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,776.23 / $3,776.23 / $3,776.23
| Facility | | $3,776.23 | $3,776.23 | $3,776.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,415.96 / $5,095.49 / $7,196.62
| Professional | | $2,415.96 | $5,095.49 | $7,196.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $119,048.80
| Facility | | $55.00 | $55.00 | $119,048.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,765.92 / $29,461.92 / $35,029.43
| Professional | | $28,765.92 | $29,461.92 | $35,029.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,910.73 / $4,277.50 / $7,024.13
| Facility | | $1,910.73 | $4,277.50 | $7,024.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,162.95 / $5,957.25 / $6,950.13
| Professional | | $5,162.95 | $5,957.25 | $6,950.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,414.60 / $2,414.60 / $2,414.60
| Professional | | $2,414.60 | $2,414.60 | $2,414.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,910.73 / $4,301.77 / $8,610.25
| Facility | | $1,910.73 | $4,301.77 | $8,610.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,611.48 / $5,272.41 / $7,825.61
| Professional | | $2,611.48 | $5,272.41 | $7,825.61 |
- 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
- $2,023.68 / $4,307.78 / $7,033.10
| Professional | | $2,023.68 | $4,307.78 | $7,033.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,389.56 / $3,885.22 / $5,307.15
| Professional | | $3,389.56 | $3,885.22 | $5,307.15 |