- 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
- $2,757.23 / $3,139.02 / $5,153.38
| Professional | | $2,757.23 | $3,139.02 | $5,153.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,729.00 / $9,943.02
| Facility | | $953.00 | $3,729.00 | $9,943.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,854.72 / $5,017.12 / $21,180.42
| Professional | | $2,854.72 | $5,017.12 | $21,180.42 |
- 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
- $3,379.65 / $4,809.18 / $8,150.55
| Professional | | $3,379.65 | $4,809.18 | $8,150.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $4,124.12 / $8,090.00
| Facility | | $300.00 | $4,124.12 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,383.90 / $4,099.01 / $5,583.42
| Professional | | $3,383.90 | $4,099.01 | $5,583.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,783.07 / $7,157.95 / $9,521.99
| Professional | | $3,783.07 | $7,157.95 | $9,521.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $40,278.14
| Facility | | $953.00 | $3,466.00 | $40,278.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,171.91 / $5,434.69 / $21,180.42
| Professional | | $3,171.91 | $5,434.69 | $21,180.42 |
- 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
- $3,136.35 / $4,441.35 / $9,194.53
| Professional | | $3,136.35 | $4,441.35 | $9,194.53 |