- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $4,806.64
| Facility | | $1,758.00 | $2,747.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $904.43 / $1,006.29 / $2,635.22
| Professional | | $904.43 | $1,006.29 | $2,635.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,061.00 / $3,438.38 / $5,737.16
| Facility | | $1,061.00 | $3,438.38 | $5,737.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.42 / $1,684.93 / $7,550.88
| Professional | | $990.42 | $1,684.93 | $7,550.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,211.29 / $1,986.27 / $2,690.88
| Professional | | $1,211.29 | $1,986.27 | $2,690.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,033.33 / $1,723.91 / $2,955.17
| Professional | | $1,033.33 | $1,723.91 | $2,955.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.89 / $1,909.00 / $6,679.00
| Facility | | $1,031.89 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.08 / $1,434.33 / $1,943.62
| Professional | | $1,184.08 | $1,434.33 | $1,943.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,289.42 / $2,556.15 / $3,371.96
| Professional | | $1,289.42 | $2,556.15 | $3,371.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,764.00 / $9,039.00
| Facility | | $55.00 | $3,764.00 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.85 / $1,761.34 / $7,550.88
| Professional | | $1,067.85 | $1,761.34 | $7,550.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,700.00 / $4,249.00 / $9,821.00
| Facility | | $1,700.00 | $4,249.00 | $9,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,067.85 / $1,633.63 / $4,177.63
| Professional | | $1,067.85 | $1,633.63 | $4,177.63 |