- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,137.13 / $6,041.88 / $10,844.40
| Facility | | $3,137.13 | $6,041.88 | $10,844.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,110.79 / $3,650.00 / $3,873.00
| Professional | | $2,110.79 | $3,650.00 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.20 / $573.20 / $7,736.32
| Professional | | $573.20 | $573.20 | $7,736.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,323.80 / $3,873.00 / $3,873.00
| Facility | | $2,323.80 | $3,873.00 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,827.29 / $3,873.00 / $3,873.00
| Professional | | $2,827.29 | $3,873.00 | $3,873.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,647.60 / $8,181.71 / $10,050.62
| Facility | | $4,647.60 | $8,181.71 | $10,050.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,362.35 / $7,867.88 / $18,667.86
| Professional | | $2,362.35 | $7,867.88 | $18,667.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.00 / $5,034.89 / $8,714.25
| Facility | | $319.00 | $5,034.89 | $8,714.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.10 / $4,040.70 / $7,087.59
| Professional | | $2,711.10 | $4,040.70 | $7,087.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,292.05 / $3,825.11 / $7,022.89
| Professional | | $3,292.05 | $3,825.11 | $7,022.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $254.50 / $9,450.00 / $10,050.62
| Facility | | $254.50 | $9,450.00 | $10,050.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,517.44 / $4,996.17 / $11,619.00
| Professional | | $2,517.44 | $4,996.17 | $11,619.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $2,323.80 / $5,869.84
| Professional | | $1,626.66 | $2,323.80 | $5,869.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,105.39 / $4,105.39 / $4,105.39
| Facility | | $4,105.39 | $4,105.39 | $4,105.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,292.05 / $3,873.00 / $4,558.51
| Professional | | $3,292.05 | $3,873.00 | $4,558.51 |