- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,734.10 / $2,747.00 / $5,454.00
| Facility | | $1,734.10 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,469.60 / $1,734.10 / $2,592.62
| Professional | | $1,469.60 | $1,734.10 | $2,592.62 |
- 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
- $1,603.57 / $2,789.35 / $11,959.44
| Professional | | $1,603.57 | $2,789.35 | $11,959.44 |
- 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
- $1,823.65 / $2,741.16 / $4,660.57
| Professional | | $1,823.65 | $2,741.16 | $4,660.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,659.39 / $8,090.00
| Facility | | $300.00 | $2,659.39 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,931.43 / $2,339.59 / $3,195.37
| Professional | | $1,931.43 | $2,339.59 | $3,195.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,151.21 / $4,070.32 / $5,414.62
| Professional | | $2,151.21 | $4,070.32 | $5,414.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $17,972.02
| Facility | | $953.00 | $3,466.00 | $17,972.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,740.70 / $3,099.40 / $11,959.44
| Professional | | $1,740.70 | $3,099.40 | $11,959.44 |
- 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
- $1,735.45 / $2,560.82 / $5,202.60
| Professional | | $1,735.45 | $2,560.82 | $5,202.60 |