- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $760.49 / $9,639.00 / $20,509.00
| Facility | | $760.49 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.64 / $760.49 / $3,996.10
| Professional | | $678.64 | $760.49 | $3,996.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,537.00 / $10,000.00 / $20,418.00
| Facility | | $3,537.00 | $10,000.00 | $20,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $946.55 / $1,239.08 / $2,372.04
| Professional | | $946.55 | $1,239.08 | $2,372.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.00 / $100.00 / $11,729.10
| Facility | | $66.00 | $100.00 | $11,729.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.16 / $830.83 / $2,035.66
| Professional | | $538.16 | $830.83 | $2,035.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.51 / $959.27 / $2,906.66
| Professional | | $731.51 | $959.27 | $2,906.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.07 / $868.29 / $1,041.95
| Professional | | $648.07 | $868.29 | $1,041.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $772.25 / $998.53 / $1,762.00
| Professional | | $772.25 | $998.53 | $1,762.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,952.50 / $16,298.90
| Facility | | $55.00 | $4,952.50 | $16,298.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,806.93 / $5,806.93 / $6,396.83
| Professional | | $5,806.93 | $5,806.93 | $6,396.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $787.70 / $1,020.91 / $1,510.34
| Facility | | $787.70 | $1,020.91 | $1,510.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.90 / $984.83 / $2,164.09
| Professional | | $731.90 | $984.83 | $2,164.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,479.51 / $2,479.51 / $2,479.51
| Professional | | $2,479.51 | $2,479.51 | $2,479.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $648.07 / $907.30 / $1,101.72
| Professional | | $648.07 | $907.30 | $1,101.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,116.00 / $9,810.00 / $22,073.00
| Facility | | $5,116.00 | $9,810.00 | $22,073.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.49 / $874.80 / $2,451.34
| Professional | | $602.49 | $874.80 | $2,451.34 |