- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,733.00 / $4,712.00
| Facility | | $1,758.00 | $2,733.00 | $4,712.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $871.51 / $1,093.33 / $1,499.96
| Professional | | $871.51 | $1,093.33 | $1,499.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,313.00 / $3,950.84 / $9,039.00
| Facility | | $1,313.00 | $3,950.84 | $9,039.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $781.24 / $1,297.98 / $6,689.76
| Professional | | $781.24 | $1,297.98 | $6,689.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.97 / $1,808.21 / $2,402.62
| Professional | | $1,365.97 | $1,808.21 | $2,402.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,346.32 / $1,346.32 / $1,346.32
| Facility | | $1,346.32 | $1,346.32 | $1,346.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.86 / $1,629.90 / $2,992.78
| Professional | | $849.86 | $1,629.90 | $2,992.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $913.79 / $1,909.00 / $6,679.00
| Facility | | $913.79 | $1,909.00 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,009.74 / $1,257.19 / $1,735.41
| Professional | | $1,009.74 | $1,257.19 | $1,735.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.94 / $2,263.62 / $3,833.81
| Professional | | $1,123.94 | $2,263.62 | $3,833.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $4,525.00 / $26,542.00
| Facility | | $1,685.00 | $4,525.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.41 / $1,332.05 / $6,689.76
| Professional | | $949.41 | $1,332.05 | $6,689.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,685.00 / $3,715.00 / $8,766.00
| Facility | | $1,685.00 | $3,715.00 | $8,766.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $925.08 / $1,317.17 / $2,905.62
| Professional | | $925.08 | $1,317.17 | $2,905.62 |