- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,879.88 / $5,412.00 / $11,024.00
| Facility | | $1,879.88 | $5,412.00 | $11,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,505.00 / $1,660.13 / $2,078.54
| Professional | | $1,505.00 | $1,660.13 | $2,078.54 |
- 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
- $1,445.97 / $1,849.07 / $3,057.06
| Professional | | $1,445.97 | $1,849.07 | $3,057.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.01 / $1,849.89 / $7,889.00
| Professional | | $1,849.01 | $1,849.89 | $7,889.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,765.39
| Facility | | $640.00 | $640.00 | $1,765.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,540.35 / $2,084.33 / $3,528.27
| Professional | | $1,540.35 | $2,084.33 | $3,528.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,502.78 / $1,923.56 / $2,239.08
| Professional | | $1,502.78 | $1,923.56 | $2,239.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,636.87 / $2,137.21 / $3,231.25
| Facility | | $1,636.87 | $2,137.21 | $3,231.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,043.00 / $2,297.00 / $3,106.00
| Professional | | $2,043.00 | $2,297.00 | $3,106.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,511.97 / $2,050.23 / $6,585.00
| Facility | | $1,511.97 | $2,050.23 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,511.97 / $2,050.23 / $6,585.00
| Professional | | $1,511.97 | $2,050.23 | $6,585.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,423.00 / $11,475.00 / $21,639.00
| Facility | | $6,423.00 | $11,475.00 | $21,639.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,249.70 / $1,878.48 / $3,075.92
| Professional | | $1,249.70 | $1,878.48 | $3,075.92 |