- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,276.89 / $2,747.00 / $4,806.64
| Facility | | $1,276.89 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,147.04 / $1,327.94 / $1,977.80
| Professional | | $1,147.04 | $1,327.94 | $1,977.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $11,997.52
| Facility | | $55.00 | $2,854.00 | $11,997.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.42 / $2,522.91 / $9,392.32
| Professional | | $1,297.42 | $2,522.91 | $9,392.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,689.40 / $2,504.92 / $3,393.32
| Professional | | $1,689.40 | $2,504.92 | $3,393.32 |
- 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
- $1,032.95 / $2,191.10 / $4,595.47
| Professional | | $1,032.95 | $2,191.10 | $4,595.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,054.19 / $6,679.00
| Facility | | $300.00 | $2,054.19 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,491.89 / $1,885.17 / $2,769.26
| Professional | | $1,491.89 | $1,885.17 | $2,769.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,644.54 / $3,220.01 / $3,981.74
| Professional | | $1,644.54 | $3,220.01 | $3,981.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.41 / $429.41 / $429.41
| Professional | | $429.41 | $429.41 | $429.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $11,997.52
| Facility | | $55.00 | $2,446.00 | $11,997.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.44 / $2,628.79 / $9,392.32
| Professional | | $1,402.44 | $2,628.79 | $9,392.32 |
- 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
- $1,358.62 / $1,862.99 / $4,525.10
| Professional | | $1,358.62 | $1,862.99 | $4,525.10 |