- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,522.75 / $2,747.00 / $4,806.64
| Facility | | $1,522.75 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,373.10 / $1,592.92 / $2,371.19
| Professional | | $1,373.10 | $1,592.92 | $2,371.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $14,419.04
| Facility | | $55.00 | $2,854.00 | $14,419.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,597.06 / $3,024.32 / $12,046.47
| Professional | | $1,597.06 | $3,024.32 | $12,046.47 |
- 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
- $1,282.08 / $2,621.57 / $5,514.84
| Professional | | $1,282.08 | $2,621.57 | $5,514.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,467.06 / $6,679.00
| Facility | | $300.00 | $2,467.06 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,791.74 / $2,264.07 / $3,325.85
| Professional | | $1,791.74 | $2,264.07 | $3,325.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,977.14 / $3,871.24 / $4,783.85
| Professional | | $1,977.14 | $3,871.24 | $4,783.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.41 / $490.41 / $490.41
| Professional | | $490.41 | $490.41 | $490.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $14,419.04
| Facility | | $55.00 | $2,446.00 | $14,419.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,716.04 / $3,146.53 / $12,046.47
| Professional | | $1,716.04 | $3,146.53 | $12,046.47 |
- 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
- $1,671.70 / $2,358.03 / $5,407.92
| Professional | | $1,671.70 | $2,358.03 | $5,407.92 |