- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,241.70 / $4,723.00 / $10,817.74
| Facility | | $1,241.70 | $4,723.00 | $10,817.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $882.35 / $972.39 / $2,049.50
| Professional | | $882.35 | $972.39 | $2,049.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,084.00 / $4,437.00 / $19,117.00
| Facility | | $2,084.00 | $4,437.00 | $19,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $859.09 / $1,212.82 / $1,887.37
| Professional | | $859.09 | $1,212.82 | $1,887.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $897.15 / $1,151.42 / $1,425.14
| Facility | | $897.15 | $1,151.42 | $1,425.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.47 / $1,343.33 / $127,498.73
| Professional | | $1,055.47 | $1,343.33 | $127,498.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,571.00 / $21,571.00 / $21,571.00
| Facility | | $21,571.00 | $21,571.00 | $21,571.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $972.65 / $1,410.50 / $1,949.56
| Professional | | $972.65 | $1,410.50 | $1,949.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,145.56 / $1,145.56 / $1,145.56
| Facility | | $1,145.56 | $1,145.56 | $1,145.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,007.50 / $1,448.95 / $1,949.56
| Professional | | $1,007.50 | $1,448.95 | $1,949.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.20 / $769.39 / $1,230.05
| Professional | | $104.20 | $769.39 | $1,230.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,206.00 / $6,231.00 / $10,075.00
| Facility | | $3,206.00 | $6,231.00 | $10,075.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.83 / $1,319.10 / $2,010.74
| Professional | | $819.83 | $1,319.10 | $2,010.74 |