- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $817.96 / $9,639.00 / $20,509.00
| Facility | | $817.96 | $9,639.00 | $20,509.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.54 / $817.96 / $4,369.25
| Professional | | $673.54 | $817.96 | $4,369.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,399.48 / $6,963.00 / $16,413.00
| Facility | | $2,399.48 | $6,963.00 | $16,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,076.77 / $1,402.40 / $2,713.45
| Professional | | $1,076.77 | $1,402.40 | $2,713.45 |
- 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
- $551.66 / $858.50 / $2,092.77
| Professional | | $551.66 | $858.50 | $2,092.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $812.73 / $1,088.70 / $2,915.66
| Professional | | $812.73 | $1,088.70 | $2,915.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.03 / $829.32 / $1,148.21
| Professional | | $548.03 | $829.32 | $1,148.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $861.16 / $1,108.28 / $1,981.14
| Professional | | $861.16 | $1,108.28 | $1,981.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $8,317.50 / $10,101.60
| Facility | | $55.00 | $8,317.50 | $10,101.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,085.28 / $6,214.64 / $7,857.23
| Professional | | $6,085.28 | $6,214.64 | $7,857.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $876.20 / $1,091.27 / $1,522.32
| Facility | | $876.20 | $1,091.27 | $1,522.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $808.70 / $1,102.86 / $2,405.04
| Professional | | $808.70 | $1,102.86 | $2,405.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,711.04 / $2,711.04 / $2,711.04
| Professional | | $2,711.04 | $2,711.04 | $2,711.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.03 / $868.09 / $1,059.21
| Professional | | $548.03 | $868.09 | $1,059.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,732.00 / $5,067.00 / $20,279.00
| Facility | | $1,732.00 | $5,067.00 | $20,279.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $699.72 / $1,018.27 / $2,840.03
| Professional | | $699.72 | $1,018.27 | $2,840.03 |