- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,336.51 / $2,747.00 / $5,454.00
| Facility | | $2,336.51 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,108.32 / $2,336.51 / $3,829.79
| Professional | | $2,108.32 | $2,336.51 | $3,829.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,729.00 / $7,629.86
| Facility | | $953.00 | $3,729.00 | $7,629.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,157.92 / $3,737.69 / $16,162.74
| Professional | | $2,157.92 | $3,737.69 | $16,162.74 |
- 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
- $2,509.21 / $3,687.29 / $6,254.39
| Professional | | $2,509.21 | $3,687.29 | $6,254.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,396.70 / $8,090.00
| Facility | | $300.00 | $3,396.70 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,594.15 / $3,142.37 / $4,284.43
| Professional | | $2,594.15 | $3,142.37 | $4,284.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,896.28 / $5,480.05 / $7,289.94
| Professional | | $2,896.28 | $5,480.05 | $7,289.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $19,814.04
| Facility | | $953.00 | $3,466.00 | $19,814.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,359.36 / $4,166.35 / $16,162.74
| Professional | | $2,359.36 | $4,166.35 | $16,162.74 |
- 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
- $2,173.28 / $3,541.40 / $6,812.94
| Professional | | $2,173.28 | $3,541.40 | $6,812.94 |