- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,992.00 / $7,494.00 / $18,309.00
| Facility | | $1,992.00 | $7,494.00 | $18,309.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $752.39 / $912.75 / $5,095.85
| Professional | | $752.39 | $912.75 | $5,095.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,776.00 / $8,484.00 / $17,774.00
| Facility | | $2,776.00 | $8,484.00 | $17,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.28 / $1,217.72 / $2,444.50
| Professional | | $972.28 | $1,217.72 | $2,444.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.00 / $100.00 / $9,677.87
| Facility | | $66.00 | $100.00 | $9,677.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $754.63 / $1,078.04 / $2,383.94
| Professional | | $754.63 | $1,078.04 | $2,383.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,813.00 / $3,101.23 / $5,554.45
| Facility | | $2,813.00 | $3,101.23 | $5,554.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.91 / $1,153.72 / $2,459.73
| Professional | | $882.91 | $1,153.72 | $2,459.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.55 / $1,066.08 / $1,439.22
| Professional | | $441.55 | $1,066.08 | $1,439.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.82 / $1,180.35 / $2,122.85
| Professional | | $841.82 | $1,180.35 | $2,122.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,353.68 / $8,957.00 / $26,542.00
| Facility | | $3,353.68 | $8,957.00 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,722.39 / $6,944.23 / $7,727.63
| Professional | | $6,722.39 | $6,944.23 | $7,727.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.03 / $1,213.50 / $1,696.86
| Facility | | $950.03 | $1,213.50 | $1,696.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $884.09 / $1,231.82 / $2,389.11
| Professional | | $884.09 | $1,231.82 | $2,389.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,904.20 / $2,904.20 / $2,904.20
| Professional | | $2,904.20 | $2,904.20 | $2,904.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.01 / $860.67 / $1,183.42
| Professional | | $574.01 | $860.67 | $1,183.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,523.00 / $9,758.00 / $21,278.00
| Facility | | $4,523.00 | $9,758.00 | $21,278.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.75 / $919.57 / $1,988.43
| Professional | | $691.75 | $919.57 | $1,988.43 |