- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $1,659.59 / $2,454.71
| Facility | | $1,548.82 | $1,659.59 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,905.46 / $2,454.71
| Professional | | $1,348.96 | $1,905.46 | $2,454.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $467.74 / $1,000.00
| Facility | | $245.47 | $467.74 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $218.78 / $218.78
| Professional | | $194.98 | $218.78 | $218.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,511.89 / $2,511.89 / $2,570.40
| Facility | | $2,511.89 | $2,511.89 | $2,570.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $302.00 / $2,137.96
| Facility | | $302.00 | $302.00 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $302.00
| Professional | | $257.04 | $257.04 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $9,772.37 / $9,772.37
| Facility | | $100.00 | $9,772.37 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $1,659.59 / $2,511.89
| Facility | | $257.04 | $1,659.59 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $2,238.72 / $2,454.71
| Professional | | $1,445.44 | $2,238.72 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $380.19 / $3,801.89
| Professional | | $218.78 | $380.19 | $3,801.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $446.68 / $2,454.71
| Facility | | $257.04 | $446.68 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $1,445.44
| Professional | | $257.04 | $257.04 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $229.09 / $2,344.23
| Facility | | $120.23 | $229.09 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $380.19 / $2,290.87
| Professional | | $128.82 | $380.19 | $2,290.87 |