- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,663.12 / $2,747.00 / $5,454.00
| Facility | | $2,663.12 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,697.55 / $2,988.75 / $5,095.72
| Professional | | $2,697.55 | $2,988.75 | $5,095.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,729.00 / $9,718.79
| Facility | | $953.00 | $3,729.00 | $9,718.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,793.01 / $4,814.38 / $20,716.25
| Professional | | $2,793.01 | $4,814.38 | $20,716.25 |
- 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
- $3,281.06 / $4,679.26 / $7,966.73
| Professional | | $3,281.06 | $4,679.26 | $7,966.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $4,030.86 / $8,090.00
| Facility | | $300.00 | $4,030.86 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,308.19 / $4,007.30 / $5,457.16
| Professional | | $3,308.19 | $4,007.30 | $5,457.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,699.92 / $7,000.62 / $9,312.70
| Professional | | $3,699.92 | $7,000.62 | $9,312.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $39,398.80
| Facility | | $953.00 | $3,466.00 | $39,398.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,103.34 / $5,313.42 / $20,716.25
| Professional | | $3,103.34 | $5,313.42 | $20,716.25 |
- 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
- $3,103.34 / $4,578.10 / $9,312.70
| Professional | | $3,103.34 | $4,578.10 | $9,312.70 |