- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,098.39 / $2,747.00 / $5,454.00
| Facility | | $2,098.39 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,893.63 / $2,098.39 / $3,543.60
| Professional | | $1,893.63 | $2,098.39 | $3,543.60 |
- 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
- $1,951.19 / $3,398.09 / $14,500.80
| Professional | | $1,951.19 | $3,398.09 | $14,500.80 |
- 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
- $2,272.09 / $3,318.05 / $5,630.36
| Professional | | $2,272.09 | $3,318.05 | $5,630.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,068.49 / $8,090.00
| Facility | | $300.00 | $3,068.49 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,334.23 / $2,827.54 / $3,857.53
| Professional | | $2,334.23 | $2,827.54 | $3,857.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,603.83 / $4,926.71 / $6,553.84
| Professional | | $2,603.83 | $4,926.71 | $6,553.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $21,765.04
| Facility | | $953.00 | $3,466.00 | $21,765.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,165.73 / $3,748.37 / $14,500.80
| Professional | | $2,165.73 | $3,748.37 | $14,500.80 |
- 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
- $2,038.18 / $3,068.49 / $6,308.37
| Professional | | $2,038.18 | $3,068.49 | $6,308.37 |