- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,267.01 / $1,419.26 / $21,879.00
| Facility | | $1,267.01 | $1,419.26 | $21,879.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,058.71 / $1,267.01 / $2,109.40
| Professional | | $1,058.71 | $1,267.01 | $2,109.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,000.00 / $8,639.91 / $79,506.39
| Facility | | $5,000.00 | $8,639.91 | $79,506.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.99 / $1,959.48 / $2,653.50
| Professional | | $1,228.99 | $1,959.48 | $2,653.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $939.81 / $1,705.82 / $2,817.15
| Professional | | $939.81 | $1,705.82 | $2,817.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,738.81 / $2,352.51 / $2,352.51
| Professional | | $1,738.81 | $2,352.51 | $2,352.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,419.26 / $21,879.00 / $23,354.00
| Facility | | $1,419.26 | $21,879.00 | $23,354.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,140.53 / $1,420.89 / $3,491.38
| Professional | | $1,140.53 | $1,420.89 | $3,491.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $2,425.50 / $3,460.60
| Professional | | $7.00 | $2,425.50 | $3,460.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $924.79 / $1,705.82 / $2,817.15
| Professional | | $924.79 | $1,705.82 | $2,817.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.70 / $1,355.70 / $1,355.70
| Facility | | $1,310.70 | $1,355.70 | $1,355.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,289.04 / $1,355.70 / $1,438.47
| Professional | | $1,289.04 | $1,355.70 | $1,438.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,304.00 / $4,563.00 / $8,261.00
| Facility | | $2,304.00 | $4,563.00 | $8,261.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $912.35 / $1,802.01 / $2,758.00
| Professional | | $912.35 | $1,802.01 | $2,758.00 |