- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $3,748.36 / $10,836.00
| Facility | | $969.00 | $3,748.36 | $10,836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,748.36 / $4,427.79 / $6,829.72
| Professional | | $3,748.36 | $4,427.79 | $6,829.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,654.25 / $5,434.33 / $9,586.14
| Professional | | $3,654.25 | $5,434.33 | $9,586.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,241.53 / $4,241.53 / $4,241.53
| Facility | | $4,241.53 | $4,241.53 | $4,241.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,777.28 / $6,389.10 / $9,236.00
| Professional | | $4,777.28 | $6,389.10 | $9,236.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $82,525.60
| Facility | | $55.00 | $55.00 | $82,525.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32,338.68 / $32,424.56 / $41,420.69
| Professional | | $32,338.68 | $32,424.56 | $41,420.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,025.24 / $5,269.39 / $10,639.35
| Facility | | $4,025.24 | $5,269.39 | $10,639.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,996.66 / $6,949.90 / $8,176.36
| Professional | | $4,996.66 | $6,949.90 | $8,176.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,355.50 / $4,355.50 / $4,355.50
| Professional | | $4,355.50 | $4,355.50 | $4,355.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,040.34 / $5,315.61 / $10,756.10
| Facility | | $4,040.34 | $5,315.61 | $10,756.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,813.05 / $6,429.65 / $9,370.36
| Professional | | $4,813.05 | $6,429.65 | $9,370.36 |
- 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
- $3,812.49 / $5,230.89 / $8,287.74
| Professional | | $3,812.49 | $5,230.89 | $8,287.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,876.82 / $4,406.27 / $6,024.82
| Professional | | $3,876.82 | $4,406.27 | $6,024.82 |