- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,040.31 / $4,574.00 / $10,024.00
| Facility | | $1,040.31 | $4,574.00 | $10,024.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.88 / $944.26 / $2,072.46
| Professional | | $642.88 | $944.26 | $2,072.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,217.00 / $5,196.00 / $11,909.00
| Facility | | $3,217.00 | $5,196.00 | $11,909.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.30 / $742.89 / $1,771.71
| Professional | | $568.30 | $742.89 | $1,771.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,177.43 / $1,990.00 / $8,917.50
| Facility | | $1,177.43 | $1,990.00 | $8,917.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,177.43 / $1,177.43 / $1,177.43
| Professional | | $1,177.43 | $1,177.43 | $1,177.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $952.18 / $952.18 / $2,203.26
| Facility | | $952.18 | $952.18 | $2,203.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.13 / $998.21 / $2,261.46
| Professional | | $620.13 | $998.21 | $2,261.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $888.26 / $2,150.89
| Facility | | $332.00 | $888.26 | $2,150.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $932.86 / $1,134.74 / $1,776.52
| Professional | | $932.86 | $1,134.74 | $1,776.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.86 / $782.58 / $1,739.67
| Professional | | $382.86 | $782.58 | $1,739.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $952.18 / $74,999.25
| Facility | | $555.00 | $952.18 | $74,999.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $674.65 / $1,022.28 / $2,145.58
| Professional | | $674.65 | $1,022.28 | $2,145.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,063.00 / $5,191.00 / $11,098.00
| Facility | | $2,063.00 | $5,191.00 | $11,098.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.41 / $860.36 / $1,866.13
| Professional | | $630.41 | $860.36 | $1,866.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,159.95 / $1,159.95 / $2,133.01
| Facility | | $1,159.95 | $1,159.95 | $2,133.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.86 / $1,159.95 / $2,085.23
| Professional | | $382.86 | $1,159.95 | $2,085.23 |