- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,422.92 / $2,747.00 / $4,806.64
| Facility | | $1,422.92 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,283.56 / $1,422.92 / $2,094.83
| Professional | | $1,283.56 | $1,422.92 | $2,094.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $24,923.36
| Facility | | $55.00 | $2,854.00 | $24,923.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,419.63 / $2,642.34 / $11,130.10
| Professional | | $1,419.63 | $2,642.34 | $11,130.10 |
- 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
- $1,283.25 / $2,326.42 / $4,760.32
| Professional | | $1,283.25 | $2,326.42 | $4,760.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,127.46 / $6,679.00
| Facility | | $300.00 | $2,127.46 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,545.11 / $1,952.43 / $2,937.37
| Professional | | $1,545.11 | $1,952.43 | $2,937.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,708.85 / $3,345.93 / $4,143.14
| Professional | | $1,708.85 | $3,345.93 | $4,143.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $24,923.36
| Facility | | $55.00 | $2,446.00 | $24,923.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,528.08 / $2,736.62 / $11,130.10
| Professional | | $1,528.08 | $2,736.62 | $11,130.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,446.00 / $4,050.00
| Facility | | $789.00 | $2,446.00 | $4,050.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,462.71 / $2,111.57 / $4,745.05
| Professional | | $1,462.71 | $2,111.57 | $4,745.05 |