- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,351.51 / $2,747.00 / $4,806.64
| Facility | | $2,351.51 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,131.96 / $2,464.53 / $3,626.41
| Professional | | $2,131.96 | $2,464.53 | $3,626.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $22,157.84
| Facility | | $55.00 | $2,854.00 | $22,157.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,328.29 / $4,630.02 / $17,349.59
| Professional | | $2,328.29 | $4,630.02 | $17,349.59 |
- 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
- $1,812.03 / $4,074.42 / $8,471.04
| Professional | | $1,812.03 | $4,074.42 | $8,471.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,472.00 / $6,679.00
| Facility | | $300.00 | $3,472.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,749.19 / $3,473.92 / $5,103.08
| Professional | | $2,749.19 | $3,473.92 | $5,103.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,041.28 / $5,954.83 / $7,359.62
| Professional | | $3,041.28 | $5,954.83 | $7,359.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $22,157.84
| Facility | | $55.00 | $2,446.00 | $22,157.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,601.34 / $4,865.78 / $17,349.59
| Professional | | $2,601.34 | $4,865.78 | $17,349.59 |
- 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
- $2,466.65 / $3,475.93 / $7,811.52
| Professional | | $2,466.65 | $3,475.93 | $7,811.52 |