- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $945.00 / $3,682.00 / $10,893.00
| Facility | | $945.00 | $3,682.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,229.89 / $3,647.78 / $5,324.61
| Professional | | $3,229.89 | $3,647.78 | $5,324.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,272.84 / $4,142.62 / $5,771.59
| Professional | | $3,272.84 | $4,142.62 | $5,771.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,264.92 / $3,264.92 / $3,391.28
| Facility | | $3,264.92 | $3,264.92 | $3,391.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,227.70 / $8,204.15 / $16,886.06
| Professional | | $4,227.70 | $8,204.15 | $16,886.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $56,301.84
| Facility | | $55.00 | $55.00 | $56,301.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,188.80 / $25,728.72 / $30,819.08
| Professional | | $25,188.80 | $25,728.72 | $30,819.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,374.63 / $4,137.55 / $7,695.77
| Facility | | $3,374.63 | $4,137.55 | $7,695.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,007.39 / $5,331.58 / $6,272.44
| Professional | | $4,007.39 | $5,331.58 | $6,272.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.00 / $3,980.70 / $8,940.40
| Professional | | $13.00 | $3,980.70 | $8,940.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,374.63 / $4,179.53 / $8,106.71
| Facility | | $3,374.63 | $4,179.53 | $8,106.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,222.89 / $8,202.23 / $10,089.00
| Professional | | $4,222.89 | $8,202.23 | $10,089.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.00 / $1,970.00 / $8,583.00
| Facility | | $385.00 | $1,970.00 | $8,583.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,814.45 / $3,828.37 / $6,052.94
| Professional | | $2,814.45 | $3,828.37 | $6,052.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,974.08 / $3,455.65 / $4,661.63
| Professional | | $2,974.08 | $3,455.65 | $4,661.63 |