- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.41 / $2,747.00 / $5,454.00
| Facility | | $1,296.41 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,108.35 / $1,296.41 / $2,144.30
| Professional | | $1,108.35 | $1,296.41 | $2,144.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,804.00 / $5,000.00 / $16,222.36
| Facility | | $1,804.00 | $5,000.00 | $16,222.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.81 / $2,123.12 / $11,130.10
| Professional | | $1,187.81 | $2,123.12 | $11,130.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,082.64 / $8,082.64 / $8,082.64
| Professional | | $8,082.64 | $8,082.64 | $8,082.64 |
- 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
- $1,428.82 / $2,018.39 / $3,393.05
| Professional | | $1,428.82 | $2,018.39 | $3,393.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,232.51 / $1,988.42 / $6,679.00
| Facility | | $1,232.51 | $1,988.42 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,414.31 / $1,713.19 / $2,333.07
| Professional | | $1,414.31 | $1,713.19 | $2,333.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,542.55 / $2,918.66 / $3,882.60
| Professional | | $1,542.55 | $2,918.66 | $3,882.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.00 / $6,238.00 / $19,842.20
| Facility | | $2,485.00 | $6,238.00 | $19,842.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.31 / $2,263.34 / $11,130.10
| Professional | | $1,300.31 | $2,263.34 | $11,130.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,485.00 / $6,474.00 / $13,737.00
| Facility | | $2,485.00 | $6,474.00 | $13,737.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,300.31 / $1,906.14 / $3,720.15
| Professional | | $1,300.31 | $1,906.14 | $3,720.15 |