- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,300.44 / $5,412.00 / $11,024.00
| Facility | | $2,300.44 | $5,412.00 | $11,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,887.03 / $2,189.23 / $2,699.33
| Professional | | $1,887.03 | $2,189.23 | $2,699.33 |
- 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
- $1,852.49 / $2,396.91 / $3,962.81
| Professional | | $1,852.49 | $2,396.91 | $3,962.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,394.80 / $2,394.80 / $7,889.00
| Professional | | $2,394.80 | $2,394.80 | $7,889.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $2,293.52
| Facility | | $640.00 | $640.00 | $2,293.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,922.77 / $2,520.12 / $4,500.45
| Professional | | $1,922.77 | $2,520.12 | $4,500.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,934.89 / $2,476.66 / $2,906.51
| Professional | | $1,934.89 | $2,476.66 | $2,906.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,103.40 / $2,629.54 / $3,824.78
| Facility | | $2,103.40 | $2,629.54 | $3,824.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,375.00 / $2,806.00 / $3,819.00
| Professional | | $2,375.00 | $2,806.00 | $3,819.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,875.92 / $2,555.03 / $6,585.00
| Facility | | $1,875.92 | $2,555.03 | $6,585.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,875.92 / $2,555.03 / $6,585.00
| Professional | | $1,875.92 | $2,555.03 | $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
- $1,580.96 / $2,322.00 / $3,896.74
| Professional | | $1,580.96 | $2,322.00 | $3,896.74 |