- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,222.01 / $5,201.00 / $11,627.00
| Facility | | $1,222.01 | $5,201.00 | $11,627.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $814.48 / $954.62 / $1,883.41
| Professional | | $814.48 | $954.62 | $1,883.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,777.00 / $6,565.00 / $30,285.00
| Facility | | $2,777.00 | $6,565.00 | $30,285.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $788.32 / $1,109.77 / $1,768.03
| Professional | | $788.32 | $1,109.77 | $1,768.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $860.54 / $1,104.43 / $1,466.82
| Facility | | $860.54 | $1,104.43 | $1,466.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.40 / $1,288.50 / $127,498.73
| Professional | | $1,012.40 | $1,288.50 | $127,498.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.38 / $1,307.75 / $1,878.97
| Professional | | $966.38 | $1,307.75 | $1,878.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,098.09 / $1,098.09 / $1,098.09
| Facility | | $1,098.09 | $1,098.09 | $1,098.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.38 / $1,327.61 / $1,878.97
| Professional | | $966.38 | $1,327.61 | $1,878.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.37 / $667.56 / $1,159.66
| Professional | | $72.37 | $667.56 | $1,159.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,793.00 / $6,557.00 / $10,989.00
| Facility | | $3,793.00 | $6,557.00 | $10,989.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.14 / $1,209.58 / $1,947.30
| Professional | | $776.14 | $1,209.58 | $1,947.30 |