- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,147.29 / $2,747.00 / $5,454.00
| Facility | | $1,147.29 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.29 / $1,967.66 / $4,340.64
| Professional | | $1,147.29 | $1,967.66 | $4,340.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,414.00 / $7,231.00
| Facility | | $789.00 | $3,414.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,544.65 / $2,773.49 / $16,656.09
| Professional | | $1,544.65 | $2,773.49 | $16,656.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,141.06 / $2,957.22 / $3,911.26
| Professional | | $2,141.06 | $2,957.22 | $3,911.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,231.16 / $3,341.05 / $5,771.54
| Professional | | $2,231.16 | $3,341.05 | $5,771.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,454.56 / $8,090.00
| Facility | | $300.00 | $2,454.56 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,811.05 / $2,252.60 / $4,027.50
| Professional | | $1,811.05 | $2,252.60 | $4,027.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,993.52 / $3,781.71 / $4,965.06
| Professional | | $1,993.52 | $3,781.71 | $4,965.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $24,173.44
| Facility | | $55.00 | $2,854.00 | $24,173.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,950.13 / $3,234.32 / $16,656.09
| Professional | | $1,950.13 | $3,234.32 | $16,656.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,935.53 / $2,589.25 / $5,017.68
| Professional | | $1,935.53 | $2,589.25 | $5,017.68 |