- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,118.16 / $2,747.00 / $4,806.64
| Facility | | $2,118.16 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,927.00 / $2,147.44 / $3,250.64
| Professional | | $1,927.00 | $2,147.44 | $3,250.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,729.00 / $15,438.16
| Facility | | $822.00 | $3,729.00 | $15,438.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,209.41 / $4,049.67 / $15,297.00
| Professional | | $2,209.41 | $4,049.67 | $15,297.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,871.71 / $3,957.41 / $5,250.40
| Professional | | $2,871.71 | $3,957.41 | $5,250.40 |
- 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
- $1,642.37 / $3,613.23 / $7,305.35
| Professional | | $1,642.37 | $3,613.23 | $7,305.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,099.25 / $6,679.00
| Facility | | $300.00 | $3,099.25 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.98 / $2,990.96 / $4,393.60
| Professional | | $2,366.98 | $2,990.96 | $4,393.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,575.96 / $5,043.75 / $6,247.60
| Professional | | $2,575.96 | $5,043.75 | $6,247.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,288.22 / $3,288.22 / $3,288.22
| Professional | | $3,288.22 | $3,288.22 | $3,288.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.00 / $3,466.00 / $19,068.32
| Facility | | $822.00 | $3,466.00 | $19,068.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,322.56 / $4,159.43 / $15,297.00
| Professional | | $2,322.56 | $4,159.43 | $15,297.00 |
- 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
- $2,226.28 / $3,338.63 / $6,930.06
| Professional | | $2,226.28 | $3,338.63 | $6,930.06 |