- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,437.87 / $9,642.49 / $57,366.12
| Facility | | $4,437.87 | $9,642.49 | $57,366.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,859.17 / $3,859.17 / $8,775.00
| Professional | | $3,859.17 | $3,859.17 | $8,775.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,456.92 / $5,821.21 / $8,577.84
| Facility | | $5,456.92 | $5,821.21 | $8,577.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $14,066.69 / $14,066.69 / $15,044.59
| Facility | | $14,066.69 | $14,066.69 | $15,044.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.81 / $1,949.81 / $1,949.81
| Facility | | $1,949.81 | $1,949.81 | $1,949.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $367.47 / $367.47 / $367.47
| Facility | | $367.47 | $367.47 | $367.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.50 / $1,326.50 / $1,326.50
| Professional | | $1,326.50 | $1,326.50 | $1,326.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $5,409.35 / $5,409.35
| Facility | | $100.00 | $5,409.35 | $5,409.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,983.66 / $3,983.66 / $3,983.66
| Professional | | $3,983.66 | $3,983.66 | $3,983.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,859.17 / $3,859.17 / $8,181.44
| Facility | | $3,859.17 | $3,859.17 | $8,181.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.00 / $1,050.00 / $1,050.00
| Professional | | $1,050.00 | $1,050.00 | $1,050.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,363.39 / $7,340.84 / $23,625.91
| Facility | | $5,363.39 | $7,340.84 | $23,625.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,859.17 / $3,859.17 / $5,788.76
| Facility | | $3,859.17 | $3,859.17 | $5,788.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.50 / $1,326.50 / $1,326.50
| Professional | | $1,326.50 | $1,326.50 | $1,326.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.01 / $40.01 / $40.01
| Professional | | $40.01 | $40.01 | $40.01 |