- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,924.00 / $7,920.26 / $20,400.00
| Facility | | $1,924.00 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.34 / $1,299.66 / $3,021.74
| Professional | | $870.34 | $1,299.66 | $3,021.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.00 / $1,040.00 / $1,040.00
| Facility | | $1,040.00 | $1,040.00 | $1,040.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,116.78 / $1,865.03 / $2,824.24
| Professional | | $1,116.78 | $1,865.03 | $2,824.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,779.00 / $2,083.78 / $2,499.94
| Professional | | $1,779.00 | $2,083.78 | $2,499.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.03 / $1,833.10 / $2,273.37
| Facility | | $1,338.03 | $1,833.10 | $2,273.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,406.07 / $1,690.12 / $2,544.96
| Professional | | $1,406.07 | $1,690.12 | $2,544.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,327.90 / $1,773.03 / $1,935.63
| Facility | | $1,327.90 | $1,773.03 | $1,935.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,338.03 / $1,920.95 / $5,949.00
| Facility | | $1,338.03 | $1,920.95 | $5,949.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,630.93 / $1,934.52 / $2,652.97
| Professional | | $1,630.93 | $1,934.52 | $2,652.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,715.78 / $10,171.54 / $12,117.15
| Facility | | $7,715.78 | $10,171.54 | $12,117.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,763.90 / $2,254.86 / $3,030.56
| Professional | | $1,763.90 | $2,254.86 | $3,030.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,912.00 / $16,268.00 / $24,231.00
| Facility | | $2,912.00 | $16,268.00 | $24,231.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.36 / $1,902.33 / $3,022.86
| Professional | | $1,323.36 | $1,902.33 | $3,022.86 |