- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $921.00 / $3,682.00 / $10,893.00
| Facility | | $921.00 | $3,682.00 | $10,893.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,262.61 / $3,855.41 / $5,941.72
| Professional | | $3,262.61 | $3,855.41 | $5,941.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,739.10 / $6,264.86 / $7,985.77
| Professional | | $3,739.10 | $6,264.86 | $7,985.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,702.86 / $3,702.86 / $3,702.86
| Facility | | $3,702.86 | $3,702.86 | $3,702.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,182.00 / $5,503.72 / $8,090.70
| Professional | | $4,182.00 | $5,503.72 | $8,090.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $55.00 / $71,838.08
| Facility | | $55.00 | $55.00 | $71,838.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28,102.02 / $28,223.44 / $36,030.60
| Professional | | $28,102.02 | $28,223.44 | $36,030.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,680.05 / $4,726.72 / $9,181.34
| Facility | | $3,680.05 | $4,726.72 | $9,181.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,138.56 / $6,047.69 / $7,114.93
| Professional | | $5,138.56 | $6,047.69 | $7,114.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,553.50 / $4,553.50 / $4,553.50
| Professional | | $4,553.50 | $4,553.50 | $4,553.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,680.05 / $4,741.22 / $9,260.59
| Facility | | $3,680.05 | $4,741.22 | $9,260.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,216.76 / $5,558.39 / $8,148.97
| Professional | | $4,216.76 | $5,558.39 | $8,148.97 |
- 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
- $3,239.83 / $4,448.09 / $7,097.93
| Professional | | $3,239.83 | $4,448.09 | $7,097.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,373.55 / $3,833.37 / $5,243.89
| Professional | | $3,373.55 | $3,833.37 | $5,243.89 |