- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,616.33 / $2,747.00 / $5,454.00
| Facility | | $1,616.33 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.73 / $1,616.33 / $2,729.32
| Professional | | $1,453.73 | $1,616.33 | $2,729.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,592.00 / $7,231.00
| Facility | | $953.00 | $3,592.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,498.71 / $2,599.01 / $11,137.08
| Professional | | $1,498.71 | $2,599.01 | $11,137.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $3,000.00
| Facility | | $2,000.00 | $2,000.00 | $3,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,747.57 / $2,557.63 / $4,349.00
| Professional | | $1,747.57 | $2,557.63 | $4,349.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,570.08 / $2,541.67 / $6,679.00
| Facility | | $1,570.08 | $2,541.67 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,801.67 / $2,182.41 / $2,982.23
| Professional | | $1,801.67 | $2,182.41 | $2,982.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,004.99 / $3,793.64 / $5,046.56
| Professional | | $2,004.99 | $3,793.64 | $5,046.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $16,745.08
| Facility | | $953.00 | $3,466.00 | $16,745.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,658.32 / $2,890.71 / $11,137.08
| Professional | | $1,658.32 | $2,890.71 | $11,137.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,372.00 / $4,662.00
| Facility | | $953.00 | $3,372.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,642.94 / $2,372.23 / $4,788.07
| Professional | | $1,642.94 | $2,372.23 | $4,788.07 |