- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,485.00 / $2,663.12 / $3,693.00
| Facility | | $1,485.00 | $2,663.12 | $3,693.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.67 / $1,268.69 / $1,863.81
| Professional | | $1,117.67 | $1,268.69 | $1,863.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $700.00 / $1,878.00 / $7,161.00
| Facility | | $700.00 | $1,878.00 | $7,161.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $978.79 / $1,602.03 / $8,349.84
| Professional | | $978.79 | $1,602.03 | $8,349.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,349.99 / $2,256.91 / $2,999.00
| Professional | | $1,349.99 | $2,256.91 | $2,999.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.00 / $50.00 / $386.47
| Facility | | $50.00 | $50.00 | $386.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,010.28 / $2,034.49 / $3,750.02
| Professional | | $1,010.28 | $2,034.49 | $3,750.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,140.33 / $1,801.72 / $6,679.00
| Facility | | $1,140.33 | $1,801.72 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.06 / $1,569.26 / $2,166.19
| Professional | | $1,260.06 | $1,569.26 | $2,166.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.40 / $2,392.62 / $3,490.95
| Professional | | $1,191.40 | $2,392.62 | $3,490.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,078.00 / $7,958.00
| Facility | | $55.00 | $2,078.00 | $7,958.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,119.89 / $1,659.96 / $8,349.84
| Professional | | $1,119.89 | $1,659.96 | $8,349.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $789.00 / $2,408.00 / $6,123.00
| Facility | | $789.00 | $2,408.00 | $6,123.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.59 / $1,515.15 / $3,536.88
| Professional | | $1,114.59 | $1,515.15 | $3,536.88 |