- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.65 / $2,747.00 / $5,454.00
| Facility | | $1,000.65 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.65 / $1,739.47 / $4,030.69
| Professional | | $1,000.65 | $1,739.47 | $4,030.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $3,390.00 / $7,231.00
| Facility | | $789.00 | $3,390.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,461.45 / $2,434.08 / $13,938.86
| Professional | | $1,461.45 | $2,434.08 | $13,938.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,887.32 / $2,798.39 / $3,712.70
| Professional | | $1,887.32 | $2,798.39 | $3,712.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,099.61 / $3,081.34 / $5,476.32
| Professional | | $2,099.61 | $3,081.34 | $5,476.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,311.92 / $8,090.00
| Facility | | $300.00 | $2,311.92 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,719.11 / $2,121.69 / $3,793.45
| Professional | | $1,719.11 | $2,121.69 | $3,793.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.45 / $3,533.07 / $4,638.62
| Professional | | $1,862.45 | $3,533.07 | $4,638.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,854.00 / $36,604.10
| Facility | | $55.00 | $2,854.00 | $36,604.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,712.98 / $3,002.95 / $13,938.86
| Professional | | $1,712.98 | $3,002.95 | $13,938.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,710.45 / $2,390.75 / $5,093.72
| Professional | | $1,710.45 | $2,390.75 | $5,093.72 |