- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,749.00 / $5,040.00 / $10,637.11
| Facility | | $1,749.00 | $5,040.00 | $10,637.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $995.40 / $1,134.80 / $1,542.52
| Professional | | $995.40 | $1,134.80 | $1,542.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,900.00 / $13,875.00 / $15,752.00
| Facility | | $10,900.00 | $13,875.00 | $15,752.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.10 / $1,292.97 / $2,137.66
| Professional | | $1,011.10 | $1,292.97 | $2,137.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,179.31 / $1,228.78 / $8,040.00
| Professional | | $1,179.31 | $1,228.78 | $8,040.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.00 / $900.00 / $1,234.82
| Facility | | $900.00 | $900.00 | $1,234.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,065.91 / $1,395.34 / $2,386.42
| Professional | | $1,065.91 | $1,395.34 | $2,386.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,039.91 / $1,331.08 / $1,567.74
| Professional | | $1,039.91 | $1,331.08 | $1,567.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,131.85 / $1,438.17 / $2,124.46
| Facility | | $1,131.85 | $1,438.17 | $2,124.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,349.00 / $1,520.00 / $2,104.00
| Professional | | $1,349.00 | $1,520.00 | $2,104.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,022.70 / $1,385.11 / $4,743.39
| Facility | | $1,022.70 | $1,385.11 | $4,743.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.70 / $1,385.11 / $4,743.39
| Professional | | $1,022.70 | $1,385.11 | $4,743.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,408.00 / $13,296.00 / $26,537.00
| Facility | | $7,408.00 | $13,296.00 | $26,537.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.63 / $1,353.01 / $2,020.87
| Professional | | $845.63 | $1,353.01 | $2,020.87 |