- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,117.36 / $2,747.00 / $4,806.64
| Facility | | $2,117.36 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,874.07 / $2,203.37 / $3,302.39
| Professional | | $1,874.07 | $2,203.37 | $3,302.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $27,408.48
| Facility | | $55.00 | $2,854.00 | $27,408.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,176.19 / $4,192.70 / $15,706.24
| Professional | | $2,176.19 | $4,192.70 | $15,706.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,006.33 / $4,142.93 / $5,496.54
| Professional | | $3,006.33 | $4,142.93 | $5,496.54 |
- 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
- $1,339.29 / $3,615.20 / $7,581.93
| Professional | | $1,339.29 | $3,615.20 | $7,581.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,240.43 / $6,679.00
| Facility | | $300.00 | $3,240.43 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,474.80 / $3,127.20 / $4,593.75
| Professional | | $2,474.80 | $3,127.20 | $4,593.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,719.33 / $5,324.45 / $6,619.27
| Professional | | $2,719.33 | $5,324.45 | $6,619.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,446.00 / $27,408.48
| Facility | | $55.00 | $2,446.00 | $27,408.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,366.27 / $4,361.70 / $15,706.24
| Professional | | $2,366.27 | $4,361.70 | $15,706.24 |
- 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
- $2,228.80 / $3,122.41 / $7,111.32
| Professional | | $2,228.80 | $3,122.41 | $7,111.32 |