- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.78 / $2,747.00 / $5,454.00
| Facility | | $1,748.78 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,574.73 / $1,748.78 / $2,907.17
| Professional | | $1,574.73 | $1,748.78 | $2,907.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,729.00 / $7,231.00
| Facility | | $953.00 | $3,729.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,622.16 / $2,838.63 / $12,062.04
| Professional | | $1,622.16 | $2,838.63 | $12,062.04 |
- 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
- $1,891.79 / $2,764.31 / $4,699.81
| Professional | | $1,891.79 | $2,764.31 | $4,699.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,696.31 / $2,744.39 / $7,315.92
| Facility | | $1,696.31 | $2,744.39 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,946.52 / $2,357.87 / $3,220.08
| Professional | | $1,946.52 | $2,357.87 | $3,220.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,168.01 / $4,102.09 / $5,456.88
| Professional | | $2,168.01 | $4,102.09 | $5,456.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $18,112.05
| Facility | | $953.00 | $3,466.00 | $18,112.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,806.71 / $3,125.65 / $12,062.04
| Professional | | $1,806.71 | $3,125.65 | $12,062.04 |
- 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
- $1,617.21 / $2,542.86 / $5,239.64
| Professional | | $1,617.21 | $2,542.86 | $5,239.64 |