- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.70 / $9,639.00 / $20,509.00
| Facility | | $1,134.70 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.55 / $1,090.03 / $5,024.92
| Professional | | $968.55 | $1,090.03 | $5,024.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,517.00 / $9,644.00 / $19,252.00
| Facility | | $3,517.00 | $9,644.00 | $19,252.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,310.69 / $1,874.20 / $3,388.55
| Professional | | $1,310.69 | $1,874.20 | $3,388.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.50 / $100.00 / $5,485.17
| Facility | | $63.50 | $100.00 | $5,485.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $807.59 / $1,236.69 / $2,692.09
| Professional | | $807.59 | $1,236.69 | $2,692.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.08 / $1,293.24 / $3,186.62
| Professional | | $1,031.08 | $1,293.24 | $3,186.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.38 / $990.05 / $1,336.57
| Professional | | $930.38 | $990.05 | $1,336.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.05 / $1,148.14 / $2,113.10
| Professional | | $891.05 | $1,148.14 | $2,113.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $10,007.91 / $12,312.96
| Facility | | $55.00 | $10,007.91 | $12,312.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,338.08 / $8,338.08 / $8,388.60
| Professional | | $8,338.08 | $8,338.08 | $8,388.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.52 / $1,381.86 / $1,865.56
| Facility | | $1,018.52 | $1,381.86 | $1,865.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.13 / $1,293.24 / $2,951.62
| Professional | | $1,014.13 | $1,293.24 | $2,951.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,117.88 / $3,117.88 / $3,117.88
| Professional | | $3,117.88 | $3,117.88 | $3,117.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.38 / $1,173.28 / $1,759.92
| Professional | | $930.38 | $1,173.28 | $1,759.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,930.00 / $6,395.00 / $18,709.00
| Facility | | $1,930.00 | $6,395.00 | $18,709.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.57 / $1,243.88 / $2,590.59
| Professional | | $861.57 | $1,243.88 | $2,590.59 |