- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,987.25 / $6,827.70 / $13,639.98
| Facility | | $1,987.25 | $6,827.70 | $13,639.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,608.38 / $1,987.25 / $2,719.22
| Professional | | $1,608.38 | $1,987.25 | $2,719.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,976.00 / $54,001.38 / $75,212.97
| Facility | | $13,976.00 | $54,001.38 | $75,212.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,592.19 / $2,060.11 / $3,405.97
| Professional | | $1,592.19 | $2,060.11 | $3,405.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,030.21 / $2,030.21 / $19,314.00
| Professional | | $2,030.21 | $2,030.21 | $19,314.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $1,977.73
| Facility | | $640.00 | $640.00 | $1,977.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,570.56 / $2,205.73 / $3,893.94
| Professional | | $1,570.56 | $2,205.73 | $3,893.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,656.45 / $2,120.26 / $2,488.94
| Professional | | $1,656.45 | $2,120.26 | $2,488.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,816.08 / $2,253.54 / $3,279.97
| Facility | | $1,816.08 | $2,253.54 | $3,279.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,999.93 / $2,501.00 / $3,304.00
| Professional | | $1,999.93 | $2,501.00 | $3,304.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,598.41 / $2,178.06 / $7,420.00
| Facility | | $1,598.41 | $2,178.06 | $7,420.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,598.41 / $2,178.06 / $7,420.00
| Professional | | $1,598.41 | $2,178.06 | $7,420.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,621.00 / $25,197.00 / $42,546.00
| Facility | | $7,621.00 | $25,197.00 | $42,546.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,315.42 / $2,009.07 / $3,394.73
| Professional | | $1,315.42 | $2,009.07 | $3,394.73 |