- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,781.42 / $12,941.00
| Facility | | $969.00 | $3,781.42 | $12,941.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,451.40 / $3,926.56 / $5,873.80
| Professional | | $3,451.40 | $3,926.56 | $5,873.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,847.85 / $4,903.89 / $6,832.22
| Professional | | $3,847.85 | $4,903.89 | $6,832.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,057.94 / $4,057.94 / $4,057.94
| Facility | | $4,057.94 | $4,057.94 | $4,057.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,152.75 / $5,444.96 / $7,550.34
| Professional | | $4,152.75 | $5,444.96 | $7,550.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $56,385.48
| Facility | | $55.00 | $55.00 | $56,385.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,918.24 / $29,534.24 / $37,356.15
| Professional | | $28,918.24 | $29,534.24 | $37,356.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,622.83 / $4,777.85 / $9,472.69
| Facility | | $3,622.83 | $4,777.85 | $9,472.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,529.47 / $6,300.10 / $7,411.88
| Professional | | $4,529.47 | $6,300.10 | $7,411.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,552.20 / $4,552.20 / $4,552.20
| Professional | | $4,552.20 | $4,552.20 | $4,552.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,622.83 / $4,835.01 / $9,714.61
| Facility | | $3,622.83 | $4,835.01 | $9,714.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,176.83 / $5,530.00 / $8,345.26
| Professional | | $4,176.83 | $5,530.00 | $8,345.26 |
- 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
- $3,206.49 / $4,451.35 / $7,356.75
| Professional | | $3,206.49 | $4,451.35 | $7,356.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,514.34 / $3,981.55 / $5,478.45
| Professional | | $3,514.34 | $3,981.55 | $5,478.45 |