- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,421.00 / $7,108.00 / $20,135.00
| Facility | | $2,421.00 | $7,108.00 | $20,135.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.47 / $1,483.30 / $3,953.23
| Professional | | $928.47 | $1,483.30 | $3,953.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,629.00 / $7,028.00 / $15,328.00
| Facility | | $2,629.00 | $7,028.00 | $15,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,125.14 / $1,462.40 / $2,879.71
| Professional | | $1,125.14 | $1,462.40 | $2,879.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.00 / $100.00 / $8,263.42
| Facility | | $66.00 | $100.00 | $8,263.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.85 / $1,052.30 / $2,579.14
| Professional | | $681.85 | $1,052.30 | $2,579.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,091.14 / $2,471.35 / $5,822.29
| Facility | | $2,091.14 | $2,471.35 | $5,822.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.92 / $1,269.22 / $3,842.93
| Professional | | $965.92 | $1,269.22 | $3,842.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.61 / $1,078.38 / $1,455.81
| Professional | | $674.61 | $1,078.38 | $1,455.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $968.36 / $1,240.26 / $2,229.85
| Professional | | $968.36 | $1,240.26 | $2,229.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,562.92 / $9,388.90 / $26,542.00
| Facility | | $3,562.92 | $9,388.90 | $26,542.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,307.00 / $7,307.00 / $8,040.53
| Professional | | $7,307.00 | $7,307.00 | $8,040.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.95 / $1,320.00 / $1,832.94
| Facility | | $1,000.95 | $1,320.00 | $1,832.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $987.70 / $1,277.94 / $2,747.82
| Professional | | $987.70 | $1,277.94 | $2,747.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,162.63 / $3,162.63 / $3,162.63
| Professional | | $3,162.63 | $3,162.63 | $3,162.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.61 / $1,011.91 / $1,276.09
| Professional | | $674.61 | $1,011.91 | $1,276.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,416.00 / $12,341.00 / $26,672.00
| Facility | | $5,416.00 | $12,341.00 | $26,672.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.32 / $1,187.44 / $3,262.66
| Professional | | $803.32 | $1,187.44 | $3,262.66 |