- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,374.46 / $2,747.00 / $5,454.00
| Facility | | $2,374.46 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,140.23 / $2,374.46 / $3,943.62
| Professional | | $2,140.23 | $2,374.46 | $3,943.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,729.00 / $7,755.92
| Facility | | $953.00 | $3,729.00 | $7,755.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,206.34 / $3,799.44 / $16,414.74
| Professional | | $2,206.34 | $3,799.44 | $16,414.74 |
- 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
- $2,532.34 / $3,746.21 / $6,357.73
| Professional | | $2,532.34 | $3,746.21 | $6,357.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,452.91 / $8,090.00
| Facility | | $300.00 | $3,452.91 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,637.08 / $3,194.37 / $4,356.89
| Professional | | $2,637.08 | $3,194.37 | $4,356.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,942.57 / $5,567.64 / $7,406.45
| Professional | | $2,942.57 | $5,567.64 | $7,406.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $24,599.19
| Facility | | $953.00 | $3,466.00 | $24,599.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,432.51 / $4,233.74 / $16,414.74
| Professional | | $2,432.51 | $4,233.74 | $16,414.74 |
- 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
- $2,318.23 / $3,445.21 / $7,126.50
| Professional | | $2,318.23 | $3,445.21 | $7,126.50 |