- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,397.91 / $7,920.26 / $20,400.00
| Facility | | $2,397.91 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.76 / $1,524.46 / $2,809.27
| Professional | | $999.76 | $1,524.46 | $2,809.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,184.00 / $1,184.00 / $1,184.00
| Facility | | $1,184.00 | $1,184.00 | $1,184.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,299.38 / $2,103.57 / $3,235.79
| Professional | | $1,299.38 | $2,103.57 | $3,235.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,023.24 / $2,371.15 / $2,843.17
| Professional | | $2,023.24 | $2,371.15 | $2,843.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,524.46 / $1,981.68 / $2,646.05
| Facility | | $1,524.46 | $1,981.68 | $2,646.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,764.60 / $1,931.40 / $2,899.53
| Professional | | $1,764.60 | $1,931.40 | $2,899.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,516.00 / $2,083.03 / $2,207.65
| Facility | | $1,516.00 | $2,083.03 | $2,207.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,524.46 / $2,173.53 / $3,865.00
| Facility | | $1,524.46 | $2,173.53 | $3,865.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,904.23 / $2,215.52 / $3,025.80
| Professional | | $1,904.23 | $2,215.52 | $3,025.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,860.72 / $21,418.17 / $26,781.36
| Facility | | $16,860.72 | $21,418.17 | $26,781.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,011.77 / $2,571.75 / $3,456.46
| Professional | | $2,011.77 | $2,571.75 | $3,456.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,028.00 / $18,628.00 / $26,255.00
| Facility | | $3,028.00 | $18,628.00 | $26,255.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,448.08 / $2,176.30 / $3,388.75
| Professional | | $1,448.08 | $2,176.30 | $3,388.75 |