- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,227.72 / $2,671.00 / $4,806.64
| Facility | | $1,227.72 | $2,671.00 | $4,806.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.39 / $1,278.04 / $1,901.39
| Professional | | $1,114.39 | $1,278.04 | $1,901.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.21 / $5,097.00 / $16,791.86
| Facility | | $1,407.21 | $5,097.00 | $16,791.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,333.96 / $2,424.78 / $9,854.73
| Professional | | $1,333.96 | $2,424.78 | $9,854.73 |
- 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
- $1,097.03 / $2,109.21 / $4,418.62
| Professional | | $1,097.03 | $2,109.21 | $4,418.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $714.00 / $2,009.30 / $6,679.00
| Facility | | $714.00 | $2,009.30 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,435.24 / $1,813.59 / $2,664.10
| Professional | | $1,435.24 | $1,813.59 | $2,664.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,582.28 / $3,123.42 / $3,940.83
| Professional | | $1,582.28 | $3,123.42 | $3,940.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,267.18 / $4,267.18 / $4,267.18
| Facility | | $4,267.18 | $4,267.18 | $4,267.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $6,280.00 / $17,314.56
| Facility | | $1,591.00 | $6,280.00 | $17,314.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,381.86 / $2,521.56 / $9,854.73
| Professional | | $1,381.86 | $2,521.56 | $9,854.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,591.00 / $4,447.00 / $12,850.00
| Facility | | $1,591.00 | $4,447.00 | $12,850.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,341.44 / $1,880.29 / $4,339.14
| Professional | | $1,341.44 | $1,880.29 | $4,339.14 |