- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,030.19 / $7,920.26 / $20,400.00
| Facility | | $2,030.19 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.57 / $1,405.99 / $3,172.17
| Professional | | $931.57 | $1,405.99 | $3,172.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.00 / $842.00 / $842.00
| Facility | | $842.00 | $842.00 | $842.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,218.47 / $1,991.36 / $2,928.50
| Professional | | $1,218.47 | $1,991.36 | $2,928.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,827.12 / $2,180.55 / $2,567.57
| Professional | | $1,827.12 | $2,180.55 | $2,567.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,183.84 / $1,718.10 / $2,509.19
| Facility | | $1,183.84 | $1,718.10 | $2,509.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,454.13 / $1,744.96 / $2,617.42
| Professional | | $1,454.13 | $1,744.96 | $2,617.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,389.91 / $1,958.41 / $2,006.65
| Facility | | $1,389.91 | $1,958.41 | $2,006.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.32 / $2,010.57 / $5,217.00
| Facility | | $1,263.32 | $2,010.57 | $5,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,797.06 / $2,062.19 / $2,758.49
| Professional | | $1,797.06 | $2,062.19 | $2,758.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,715.78 / $9,638.43 / $12,117.15
| Facility | | $7,715.78 | $9,638.43 | $12,117.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,811.88 / $2,324.33 / $3,123.92
| Professional | | $1,811.88 | $2,324.33 | $3,123.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $12,835.00 / $26,404.00
| Facility | | $2,155.00 | $12,835.00 | $26,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.30 / $2,023.78 / $3,052.06
| Professional | | $1,374.30 | $2,023.78 | $3,052.06 |