- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,062.38 / $9,639.00 / $20,509.00
| Facility | | $1,062.38 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $920.39 / $1,025.15 / $4,779.46
| Professional | | $920.39 | $1,025.15 | $4,779.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,640.00 / $8,323.29 / $17,015.00
| Facility | | $3,640.00 | $8,323.29 | $17,015.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,326.97 / $1,809.57 / $3,206.98
| Professional | | $1,326.97 | $1,809.57 | $3,206.98 |
- 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
- $787.31 / $1,210.63 / $2,585.14
| Professional | | $787.31 | $1,210.63 | $2,585.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.36 / $1,207.30 / $2,969.96
| Professional | | $972.36 | $1,207.30 | $2,969.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.74 / $939.18 / $1,267.89
| Professional | | $863.74 | $939.18 | $1,267.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.26 / $1,090.55 / $2,006.22
| Professional | | $845.26 | $1,090.55 | $2,006.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $9,510.49 / $11,704.66
| Facility | | $55.00 | $9,510.49 | $11,704.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,574.00 / $10,574.00 / $10,574.00
| Professional | | $10,574.00 | $10,574.00 | $10,574.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $957.88 / $1,323.87 / $2,105.42
| Facility | | $957.88 | $1,323.87 | $2,105.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.36 / $1,209.97 / $2,740.46
| Professional | | $972.36 | $1,209.97 | $2,740.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,965.56 / $2,965.56 / $2,965.56
| Professional | | $2,965.56 | $2,965.56 | $2,965.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $863.74 / $1,089.24 / $1,633.86
| Professional | | $863.74 | $1,089.24 | $1,633.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,047.00 / $5,319.00 / $20,279.00
| Facility | | $2,047.00 | $5,319.00 | $20,279.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.70 / $1,185.11 / $2,424.21
| Professional | | $812.70 | $1,185.11 | $2,424.21 |