- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,525.17 / $2,747.00 / $5,454.00
| Facility | | $2,525.17 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,277.46 / $2,525.17 / $4,080.84
| Professional | | $2,277.46 | $2,525.17 | $4,080.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,729.00 / $8,242.11
| Facility | | $953.00 | $3,729.00 | $8,242.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,348.11 / $4,037.61 / $17,467.80
| Professional | | $2,348.11 | $4,037.61 | $17,467.80 |
- 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
- $2,678.02 / $3,980.47 / $6,756.26
| Professional | | $2,678.02 | $3,980.47 | $6,756.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $300.00 / $3,504.00 / $8,090.00
| Facility | | $300.00 | $3,504.00 | $8,090.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,802.33 / $3,394.55 / $4,628.29
| Professional | | $2,802.33 | $3,394.55 | $4,628.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,128.52 / $5,919.47 / $7,874.48
| Professional | | $3,128.52 | $5,919.47 | $7,874.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $38,048.64
| Facility | | $953.00 | $3,466.00 | $38,048.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,521.02 / $4,500.64 / $17,467.80
| Professional | | $2,521.02 | $4,500.64 | $17,467.80 |
- 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
- $2,371.19 / $3,661.12 / $7,400.44
| Professional | | $2,371.19 | $3,661.12 | $7,400.44 |