- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,174.90 / $4,786.30 / $8,317.64
| Facility | | $1,174.90 | $4,786.30 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,174.90 / $2,951.21
| Professional | | $1,000.00 | $1,174.90 | $2,951.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,801.89 / $4,466.84 / $57,543.99
| Facility | | $3,801.89 | $4,466.84 | $57,543.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,479.11 / $2,089.30
| Professional | | $1,000.00 | $1,479.11 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,445.44 / $2,290.87
| Professional | | $1,000.00 | $1,445.44 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $2,041.74
| Professional | | $1,412.54 | $1,778.28 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $2,137.96
| Professional | | $1,047.13 | $1,479.11 | $2,137.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $3,801.89 / $8,317.64
| Facility | | $1,023.29 | $3,801.89 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,412.54 / $3,715.35
| Professional | | $1,000.00 | $1,412.54 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $2,290.87
| Facility | | $1,348.96 | $1,348.96 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,995.26 / $2,344.23
| Professional | | $1,174.90 | $1,995.26 | $2,344.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $478.63 / $1,122.02
| Facility | | $478.63 | $478.63 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $954.99 / $1,122.02
| Professional | | $478.63 | $954.99 | $1,122.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,311.31 / $6,309.57
| Facility | | $1,348.96 | $3,311.31 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,380.38 / $2,238.72
| Professional | | $1,047.13 | $1,380.38 | $2,238.72 |