- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,197.85 / $7,945.00 / $19,860.00
| Facility | | $2,197.85 | $7,945.00 | $19,860.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $855.23 / $1,055.51 / $4,733.84
| Professional | | $855.23 | $1,055.51 | $4,733.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,403.00 / $10,099.00 / $23,679.00
| Facility | | $3,403.00 | $10,099.00 | $23,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,022.19 / $1,339.76 / $2,627.30
| Professional | | $1,022.19 | $1,339.76 | $2,627.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.40 / $100.00 / $5,620.13
| Facility | | $64.40 | $100.00 | $5,620.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.40 / $881.09 / $2,165.13
| Professional | | $572.40 | $881.09 | $2,165.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.19 / $1,174.02 / $3,570.61
| Professional | | $852.19 | $1,174.02 | $3,570.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.97 / $1,006.86 / $1,208.23
| Professional | | $693.97 | $1,006.86 | $1,208.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $901.82 / $1,157.89 / $2,078.98
| Professional | | $901.82 | $1,157.89 | $2,078.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,314.56 / $54,004.00
| Facility | | $55.00 | $3,314.56 | $54,004.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,662.00 / $6,696.32 / $7,483.28
| Professional | | $6,662.00 | $6,696.32 | $7,483.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.76 / $1,197.20 / $1,610.98
| Facility | | $917.76 | $1,197.20 | $1,610.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $880.88 / $1,176.05 / $2,552.07
| Professional | | $880.88 | $1,176.05 | $2,552.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,937.25 / $2,937.25 / $2,937.25
| Professional | | $2,937.25 | $2,937.25 | $2,937.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.97 / $1,040.95 / $1,312.72
| Professional | | $693.97 | $1,040.95 | $1,312.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.00 / $2,753.00 / $11,305.00
| Facility | | $1,407.00 | $2,753.00 | $11,305.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $726.89 / $1,038.40 / $2,859.80
| Professional | | $726.89 | $1,038.40 | $2,859.80 |