- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,020.00 / $4,734.25 / $8,247.00
| Facility | | $1,020.00 | $4,734.25 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,956.89 / $4,452.13 / $6,287.42
| Professional | | $3,956.89 | $4,452.13 | $6,287.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $46,480.74
| Facility | | $13,531.00 | $27,840.00 | $46,480.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,635.79 / $4,810.72 / $4,810.72
| Professional | | $4,635.79 | $4,810.72 | $4,810.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.45 / $5,904.07 / $9,729.65
| Professional | | $4,365.45 | $5,904.07 | $9,729.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,798.90 / $7,860.36 / $7,860.36
| Professional | | $5,798.90 | $7,860.36 | $7,860.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $4,761.00 / $8,247.00
| Facility | | $832.00 | $4,761.00 | $8,247.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,903.31 / $4,734.25 / $11,646.30
| Professional | | $3,903.31 | $4,734.25 | $11,646.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.00 / $3,824.30 / $11,467.90
| Professional | | $15.00 | $3,824.30 | $11,467.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,365.45 / $5,918.54 / $9,940.28
| Professional | | $4,365.45 | $5,918.54 | $9,940.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.53 / $4,525.42 / $4,525.42
| Facility | | $3,468.53 | $4,525.42 | $4,525.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,468.53 / $4,525.42 / $4,793.22
| Professional | | $3,468.53 | $4,525.42 | $4,793.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $625.00 / $2,391.00 / $6,322.00
| Facility | | $625.00 | $2,391.00 | $6,322.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,225.80 / $6,341.42 / $9,577.98
| Professional | | $4,225.80 | $6,341.42 | $9,577.98 |