- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.07 / $10,449.29
| Facility | | $0.02 | $0.07 | $10,449.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,987.00 / $2,860.58 / $15,031.10
| Professional | | $1,987.00 | $2,860.58 | $15,031.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,916.87 / $5,774.00 / $11,501.24
| Facility | | $1,916.87 | $5,774.00 | $11,501.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $2,337.65 / $2,337.65
| Facility | | $80.00 | $2,337.65 | $2,337.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,557.18 / $5,135.81 / $10,414.90
| Facility | | $1,557.18 | $5,135.81 | $10,414.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,184.63 / $2,220.66 / $3,680.32
| Professional | | $1,184.63 | $2,220.66 | $3,680.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,740.24 / $11,103.84 / $11,103.84
| Facility | | $3,740.24 | $11,103.84 | $11,103.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11,688.25 / $11,688.25 / $17,532.38
| Professional | | $11,688.25 | $11,688.25 | $17,532.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,103.89 / $2,337.65 / $3,506.48
| Facility | | $2,103.89 | $2,337.65 | $3,506.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,337.65 / $2,337.65 / $2,922.06
| Professional | | $2,337.65 | $2,337.65 | $2,922.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.47 / $2,805.18 / $5,259.71
| Professional | | $1,519.47 | $2,805.18 | $5,259.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,635.04 / $3,038.95 / $9,889.12
| Facility | | $1,635.04 | $3,038.95 | $9,889.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,192.14 / $2,688.30 / $3,680.32
| Professional | | $1,192.14 | $2,688.30 | $3,680.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $981.81 / $2,337.65 / $2,805.18
| Facility | | $981.81 | $2,337.65 | $2,805.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $981.81 / $981.81 / $1,660.97
| Professional | | $981.81 | $981.81 | $1,660.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.14 / $911.68 / $2,337.65
| Professional | | $423.14 | $911.68 | $2,337.65 |