- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,054.00 / $2,158.48 / $4,846.00
| Facility | | $2,054.00 | $2,158.48 | $4,846.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,878.36 / $2,158.48 / $2,785.14
| Professional | | $1,878.36 | $2,158.48 | $2,785.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,575.00 / $24,214.00 / $45,778.00
| Facility | | $2,575.00 | $24,214.00 | $45,778.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,258.69 / $2,981.83 / $4,025.47
| Professional | | $2,258.69 | $2,981.83 | $4,025.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,703.32 / $2,170.90 / $2,504.88
| Facility | | $1,703.32 | $2,170.90 | $2,504.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,753.42 / $2,003.90 / $2,504.88
| Professional | | $1,753.42 | $2,003.90 | $2,504.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,848.98 / $3,039.41 / $7,350.51
| Professional | | $1,848.98 | $3,039.41 | $7,350.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,403.00 / $5,242.00 / $10,843.00
| Facility | | $1,403.00 | $5,242.00 | $10,843.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.99 / $2,744.51 / $4,044.76
| Professional | | $1,869.99 | $2,744.51 | $4,044.76 |