- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,116.88 / $9,639.00 / $20,509.00
| Facility | | $1,116.88 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $999.23 / $1,071.58 / $4,169.06
| Professional | | $999.23 | $1,071.58 | $4,169.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,612.00 / $11,393.00 / $22,145.00
| Facility | | $3,612.00 | $11,393.00 | $22,145.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,397.67 / $1,996.51 / $3,686.21
| Professional | | $1,397.67 | $1,996.51 | $3,686.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.50 / $98.70 / $13,719.51
| Facility | | $63.50 | $98.70 | $13,719.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $815.81 / $1,253.58 / $2,744.86
| Professional | | $815.81 | $1,253.58 | $2,744.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.33 / $1,347.27 / $3,444.93
| Professional | | $1,087.33 | $1,347.27 | $3,444.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.26 / $1,063.42 / $1,492.11
| Professional | | $843.26 | $1,063.42 | $1,492.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,020.26 / $1,325.59 / $2,771.57
| Professional | | $1,020.26 | $1,325.59 | $2,771.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $26,030.68 / $32,211.40
| Facility | | $55.00 | $26,030.68 | $32,211.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9,375.00 / $10,431.70 / $10,431.70
| Professional | | $9,375.00 | $10,431.70 | $10,431.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,086.89 / $1,439.26 / $1,980.00
| Facility | | $1,086.89 | $1,439.26 | $1,980.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.33 / $1,334.72 / $3,010.74
| Professional | | $1,087.33 | $1,334.72 | $3,010.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,443.22 / $3,443.22 / $3,443.22
| Professional | | $3,443.22 | $3,443.22 | $3,443.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.26 / $1,180.56 / $1,595.13
| Professional | | $843.26 | $1,180.56 | $1,595.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $5,159.00 / $20,279.00
| Facility | | $2,047.00 | $5,159.00 | $20,279.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $908.87 / $1,284.94 / $2,828.63
| Professional | | $908.87 | $1,284.94 | $2,828.63 |