- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,792.97 / $2,747.00 / $4,806.64
| Facility | | $1,792.97 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,645.98 / $1,879.65 / $2,965.65
| Professional | | $1,645.98 | $1,879.65 | $2,965.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $16,900.40
| Facility | | $55.00 | $2,854.00 | $16,900.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,835.46 / $3,536.23 / $13,233.20
| Professional | | $1,835.46 | $3,536.23 | $13,233.20 |
- 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
- $938.84 / $3,076.02 / $6,460.17
| Professional | | $938.84 | $3,076.02 | $6,460.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,867.00 / $6,679.00
| Facility | | $300.00 | $2,867.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.55 / $2,650.50 / $3,893.49
| Professional | | $2,097.55 | $2,650.50 | $3,893.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,319.16 / $4,540.92 / $5,614.88
| Professional | | $2,319.16 | $4,540.92 | $5,614.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $16,900.40
| Facility | | $55.00 | $2,446.00 | $16,900.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,986.01 / $3,716.15 / $13,233.20
| Professional | | $1,986.01 | $3,716.15 | $13,233.20 |
- 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
- $1,845.95 / $2,733.17 / $6,064.84
| Professional | | $1,845.95 | $2,733.17 | $6,064.84 |