- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,006.08 / $2,747.00 / $5,454.00
| Facility | | $2,006.08 | $2,747.00 | $5,454.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,006.08 / $2,462.07 / $3,743.10
| Professional | | $2,006.08 | $2,462.07 | $3,743.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,729.00 / $8,101.23
| Facility | | $953.00 | $3,729.00 | $8,101.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,270.27 / $4,054.19 / $16,978.72
| Professional | | $2,270.27 | $4,054.19 | $16,978.72 |
- 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
- $2,578.57 / $3,882.70 / $6,640.78
| Professional | | $2,578.57 | $3,882.70 | $6,640.78 |
- 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
- $2,755.22 / $3,337.47 / $4,550.96
| Professional | | $2,755.22 | $3,337.47 | $4,550.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,075.69 / $5,819.51 / $7,741.51
| Professional | | $3,075.69 | $5,819.51 | $7,741.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $3,466.00 / $37,405.28
| Facility | | $953.00 | $3,466.00 | $37,405.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.96 / $4,336.60 / $16,978.72
| Professional | | $2,549.96 | $4,336.60 | $16,978.72 |
- 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
- $2,386.35 / $3,561.54 / $7,477.05
| Professional | | $2,386.35 | $3,561.54 | $7,477.05 |