- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,639.79 / $2,747.00 / $5,454.00
| Facility | | $2,639.79 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,381.17 / $2,639.79 / $4,488.95
| Professional | | $2,381.17 | $2,639.79 | $4,488.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,729.00 / $8,610.04
| Facility | | $953.00 | $3,729.00 | $8,610.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,457.16 / $4,307.10 / $18,267.18
| Professional | | $2,457.16 | $4,307.10 | $18,267.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $16,751.97 / $16,751.97 / $16,751.97
| Professional | | $16,751.97 | $16,751.97 | $16,751.97 |
- 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
- $2,950.30 / $4,160.18 / $7,057.87
| Professional | | $2,950.30 | $4,160.18 | $7,057.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,571.67 / $8,090.00
| Facility | | $300.00 | $3,571.67 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,928.45 / $3,547.32 / $4,835.49
| Professional | | $2,928.45 | $3,547.32 | $4,835.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,270.66 / $6,188.42 / $8,232.25
| Professional | | $3,270.66 | $6,188.42 | $8,232.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $27,351.06
| Facility | | $953.00 | $3,466.00 | $27,351.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,757.38 / $4,702.66 / $18,267.18
| Professional | | $2,757.38 | $4,702.66 | $18,267.18 |
- 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
- $2,455.61 / $3,846.42 / $7,927.15
| Professional | | $2,455.61 | $3,846.42 | $7,927.15 |