- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,610.14 / $5,412.00 / $11,024.00
| Facility | | $2,610.14 | $5,412.00 | $11,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,056.16 / $2,373.09 / $3,055.04
| Professional | | $2,056.16 | $2,373.09 | $3,055.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,685.00 / $17,371.00 / $24,194.30
| Facility | | $8,685.00 | $17,371.00 | $24,194.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,111.94 / $2,700.70 / $4,465.06
| Professional | | $2,111.94 | $2,700.70 | $4,465.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,689.06 / $2,700.19 / $7,889.00
| Professional | | $2,689.06 | $2,700.19 | $7,889.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $2,592.29
| Facility | | $640.00 | $640.00 | $2,592.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,247.44 / $2,946.18 / $5,105.34
| Professional | | $2,247.44 | $2,946.18 | $5,105.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,177.21 / $2,786.83 / $3,262.84
| Professional | | $2,177.21 | $2,786.83 | $3,262.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,373.09 / $3,053.86 / $4,457.02
| Facility | | $2,373.09 | $3,053.86 | $4,457.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,806.00 / $3,273.13 / $4,626.00
| Professional | | $2,806.00 | $3,273.13 | $4,626.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,185.61 / $2,952.38 / $6,585.00
| Facility | | $2,185.61 | $2,952.38 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,185.61 / $2,952.38 / $6,585.00
| Professional | | $2,185.61 | $2,952.38 | $6,585.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,398.00 / $10,000.00 / $21,639.00
| Facility | | $6,398.00 | $10,000.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,795.97 / $2,809.28 / $4,442.08
| Professional | | $1,795.97 | $2,809.28 | $4,442.08 |