- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,888.03 / $2,747.00 / $5,454.00
| Facility | | $1,888.03 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,703.63 / $1,888.03 / $3,110.91
| Professional | | $1,703.63 | $1,888.03 | $3,110.91 |
- 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
- $1,754.21 / $3,045.43 / $13,032.78
| Professional | | $1,754.21 | $3,045.43 | $13,032.78 |
- 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
- $2,070.10 / $2,989.81 / $5,078.35
| Professional | | $2,070.10 | $2,989.81 | $5,078.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,867.00 / $8,090.00
| Facility | | $300.00 | $2,867.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,103.96 / $2,548.59 / $3,479.36
| Professional | | $2,103.96 | $2,548.59 | $3,479.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.55 / $4,436.12 / $5,901.23
| Professional | | $2,344.55 | $4,436.12 | $5,901.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $16,028.55
| Facility | | $953.00 | $3,466.00 | $16,028.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,944.51 / $3,378.55 / $13,032.78
| Professional | | $1,944.51 | $3,378.55 | $13,032.78 |
- 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
- $1,941.34 / $2,759.10 / $5,361.61
| Professional | | $1,941.34 | $2,759.10 | $5,361.61 |