- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,388.44 / $5,623.41
| Facility | | $2,691.53 | $3,388.44 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,801.89 / $9,120.11
| Professional | | $3,235.94 | $3,801.89 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,570.40 / $31,622.78
| Facility | | $56.23 | $2,570.40 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,011.87 / $26,302.68
| Professional | | $3,235.94 | $5,011.87 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $741.31 / $1,380.38
| Facility | | $50.12 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $4,570.88 / $9,332.54
| Professional | | $588.84 | $4,570.88 | $9,332.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $4,786.30 / $8,511.38
| Facility | | $302.00 | $4,786.30 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,467.37 / $4,786.30 / $6,760.83
| Professional | | $3,467.37 | $4,786.30 | $6,760.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,454.71 / $4,677.35
| Facility | | $295.12 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $6,025.60 / $9,120.11
| Professional | | $3,388.44 | $6,025.60 | $9,120.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,570.40 / $31,622.78
| Facility | | $56.23 | $2,570.40 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,011.87 / $26,302.68
| Professional | | $3,235.94 | $5,011.87 | $26,302.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,754.23 / $4,677.35
| Facility | | $794.33 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,311.31 / $4,897.79 / $10,000.00
| Professional | | $3,311.31 | $4,897.79 | $10,000.00 |