- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.64 / $2,747.00 / $4,806.64
| Facility | | $1,406.64 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,336.39 / $1,499.04 / $2,196.67
| Professional | | $1,336.39 | $1,499.04 | $2,196.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $26,286.56
| Facility | | $55.00 | $2,854.00 | $26,286.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,547.85 / $2,793.19 / $10,702.45
| Professional | | $1,547.85 | $2,793.19 | $10,702.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.37 / $2,716.28 / $3,679.63
| Professional | | $1,656.37 | $2,716.28 | $3,679.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $680.00 / $748.00
| Facility | | $50.00 | $680.00 | $748.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.76 / $2,452.19 / $5,022.33
| Professional | | $1,365.76 | $2,452.19 | $5,022.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,241.39 / $6,679.00
| Facility | | $300.00 | $2,241.39 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,627.84 / $2,056.96 / $3,172.79
| Professional | | $1,627.84 | $2,056.96 | $3,172.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,803.47 / $3,531.19 / $4,373.32
| Professional | | $1,803.47 | $3,531.19 | $4,373.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,364.91 / $6,364.91 / $6,833.47
| Professional | | $6,364.91 | $6,364.91 | $6,833.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $26,286.56
| Facility | | $55.00 | $2,446.00 | $26,286.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,651.17 / $2,895.52 / $10,702.45
| Professional | | $1,651.17 | $2,895.52 | $10,702.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $2,733.00 / $4,256.00
| Facility | | $822.00 | $2,733.00 | $4,256.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,575.85 / $2,272.26 / $4,953.51
| Professional | | $1,575.85 | $2,272.26 | $4,953.51 |