- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $2,747.00 / $7,625.00
| Facility | | $1,758.00 | $2,747.00 | $7,625.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,234.15 / $1,447.37 / $4,106.21
| Professional | | $1,234.15 | $1,447.37 | $4,106.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.00 / $6,078.00 / $25,526.57
| Facility | | $2,089.00 | $6,078.00 | $25,526.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,333.06 / $2,416.50 / $9,902.24
| Professional | | $1,333.06 | $2,416.50 | $9,902.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,790.75 / $2,655.19 / $4,018.66
| Professional | | $1,790.75 | $2,655.19 | $4,018.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,633.41 / $20,683.62 / $20,683.62
| Facility | | $20,633.41 | $20,683.62 | $20,683.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,402.42 / $2,309.15 / $3,952.65
| Professional | | $1,402.42 | $2,309.15 | $3,952.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,369.32 / $2,214.23 / $7,315.92
| Facility | | $1,369.32 | $2,214.23 | $7,315.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,571.29 / $1,903.35 / $2,598.02
| Professional | | $1,571.29 | $1,903.35 | $2,598.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,710.08 / $3,390.06 / $4,472.03
| Professional | | $1,710.08 | $3,390.06 | $4,472.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $6,418.75 / $33,500.00
| Facility | | $2,386.00 | $6,418.75 | $33,500.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.69 / $2,540.71 / $9,902.24
| Professional | | $1,471.69 | $2,540.71 | $9,902.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,453.62 / $2,136.55 / $4,446.56
| Professional | | $1,453.62 | $2,136.55 | $4,446.56 |