- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.00 / $7,920.26 / $20,400.00
| Facility | | $1,758.00 | $7,920.26 | $20,400.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.70 / $1,100.40 / $2,581.71
| Professional | | $741.70 | $1,100.40 | $2,581.71 |
- 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
- $971.93 / $1,565.82 / $2,419.90
| Professional | | $971.93 | $1,565.82 | $2,419.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,518.31 / $1,778.43 / $2,133.61
| Professional | | $1,518.31 | $1,778.43 | $2,133.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,045.38 / $1,481.18 / $1,977.06
| Facility | | $1,045.38 | $1,481.18 | $1,977.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,260.72 / $1,443.62 / $2,173.77
| Professional | | $1,260.72 | $1,443.62 | $2,173.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,149.23 / $1,557.08 / $1,654.23
| Facility | | $1,149.23 | $1,557.08 | $1,654.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,082.35 / $1,576.74 / $5,217.00
| Facility | | $1,082.35 | $1,576.74 | $5,217.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,422.41 / $1,663.52 / $2,267.28
| Professional | | $1,422.41 | $1,663.52 | $2,267.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,527.70 / $20,006.47 / $24,937.25
| Facility | | $15,527.70 | $20,006.47 | $24,937.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,506.82 / $1,927.05 / $2,589.98
| Professional | | $1,506.82 | $1,927.05 | $2,589.98 |
- 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
- $1,155.90 / $1,663.09 / $2,538.21
| Professional | | $1,155.90 | $1,663.09 | $2,538.21 |