- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.88 / $2,747.00 / $5,454.00
| Facility | | $1,438.88 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,289.24 / $1,438.88 / $2,400.71
| Professional | | $1,289.24 | $1,438.88 | $2,400.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,411.20 / $7,231.00
| Facility | | $953.00 | $3,411.20 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.50 / $2,303.92 / $10,274.83
| Professional | | $1,318.50 | $2,303.92 | $10,274.83 |
- 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
- $1,550.99 / $2,265.78 / $3,797.92
| Professional | | $1,550.99 | $2,265.78 | $3,797.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,393.03 / $2,254.79 / $7,315.92
| Facility | | $1,393.03 | $2,254.79 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,598.50 / $1,936.31 / $2,645.61
| Professional | | $1,598.50 | $1,936.31 | $2,645.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,779.30 / $3,366.61 / $4,478.50
| Professional | | $1,779.30 | $3,366.61 | $4,478.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $14,861.44
| Facility | | $953.00 | $3,466.00 | $14,861.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.14 / $2,562.44 / $10,274.83
| Professional | | $1,445.14 | $2,562.44 | $10,274.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,325.00 / $4,662.00
| Facility | | $953.00 | $3,325.00 | $4,662.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,365.48 / $2,106.66 / $4,139.07
| Professional | | $1,365.48 | $2,106.66 | $4,139.07 |