- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,904.75 / $10,119.50 / $27,817.80
| Facility | | $2,904.75 | $10,119.50 | $27,817.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,517.44 / $3,253.32 / $3,640.62
| Professional | | $2,517.44 | $3,253.32 | $3,640.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $614.00 / $7,481.47 / $19,283.66
| Facility | | $614.00 | $7,481.47 | $19,283.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.20 / $4,416.60 / $8,886.62
| Professional | | $573.20 | $4,416.60 | $8,886.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.30 / $5,112.35 / $34,740.81
| Facility | | $59.30 | $5,112.35 | $34,740.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,762.22 / $2,517.44 / $6,328.62
| Professional | | $1,762.22 | $2,517.44 | $6,328.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,632.64 / $6,495.02 / $12,964.87
| Facility | | $2,632.64 | $6,495.02 | $12,964.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,633.64 / $2,633.64 / $2,633.64
| Professional | | $2,633.64 | $2,633.64 | $2,633.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,098.40 / $3,873.00 / $5,228.55
| Professional | | $3,098.40 | $3,873.00 | $5,228.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,485.70 / $4,453.95 / $8,443.14
| Professional | | $3,485.70 | $4,453.95 | $8,443.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,739.02 / $18,396.75 / $18,396.75
| Facility | | $6,739.02 | $18,396.75 | $18,396.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19,365.00 / $19,365.00 / $29,047.50
| Professional | | $19,365.00 | $19,365.00 | $29,047.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,672.13 / $5,563.56 / $11,731.32
| Facility | | $2,672.13 | $5,563.56 | $11,731.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $4,260.30 / $5,809.50
| Professional | | $3,873.00 | $4,260.30 | $5,809.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,873.00 / $3,873.00 / $3,873.00
| Professional | | $3,873.00 | $3,873.00 | $3,873.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,098.40 / $3,485.70 / $5,267.28
| Professional | | $3,098.40 | $3,485.70 | $5,267.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,626.66 / $1,742.85 / $7,694.88
| Professional | | $1,626.66 | $1,742.85 | $7,694.88 |