- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,612.30 / $2,747.00 / $5,454.00
| Facility | | $1,612.30 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,454.21 / $1,612.30 / $2,690.37
| Professional | | $1,454.21 | $1,612.30 | $2,690.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,592.00 / $7,231.00
| Facility | | $953.00 | $3,592.00 | $7,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,497.96 / $2,601.94 / $11,107.68
| Professional | | $1,497.96 | $2,601.94 | $11,107.68 |
- 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
- $1,770.61 / $2,561.92 / $4,353.92
| Professional | | $1,770.61 | $2,561.92 | $4,353.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $2,482.81 / $8,090.00
| Facility | | $300.00 | $2,482.81 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,803.18 / $2,184.25 / $2,985.40
| Professional | | $1,803.18 | $2,184.25 | $2,985.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,006.22 / $3,928.18 / $5,246.47
| Professional | | $2,006.22 | $3,928.18 | $5,246.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $13,707.99
| Facility | | $953.00 | $3,466.00 | $13,707.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,657.89 / $2,893.34 / $11,107.68
| Professional | | $1,657.89 | $2,893.34 | $11,107.68 |
- 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
- $1,545.70 / $2,357.10 / $5,285.14
| Professional | | $1,545.70 | $2,357.10 | $5,285.14 |