- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,189.69 / $7,628.45 / $20,970.00
| Facility | | $2,189.69 | $7,628.45 | $20,970.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,591.18 / $2,423.27 / $2,481.66
| Professional | | $1,591.18 | $2,423.27 | $2,481.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $14,627.20
| Facility | | $244.00 | $614.00 | $14,627.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $239.20 / $391.04
| Professional | | $208.00 | $239.20 | $391.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.00 / $4,408.60 / $8,028.90
| Facility | | $97.00 | $4,408.60 | $8,028.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,328.42 / $1,897.74 / $4,745.30
| Professional | | $1,328.42 | $1,897.74 | $4,745.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,955.10 / $3,377.98 / $7,382.21
| Facility | | $1,955.10 | $3,377.98 | $7,382.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,919.60 / $3,211.56 / $3,941.46
| Professional | | $2,919.60 | $3,211.56 | $3,941.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,627.64 / $3,357.54 / $5,576.44
| Professional | | $2,627.64 | $3,357.54 | $5,576.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,080.10 / $13,868.10 / $13,868.10
| Facility | | $5,080.10 | $13,868.10 | $13,868.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14,539.61 / $14,539.61 / $21,897.00
| Professional | | $14,539.61 | $14,539.61 | $21,897.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,335.67 / $3,503.52 / $6,515.13
| Facility | | $2,335.67 | $3,503.52 | $6,515.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,919.60 / $3,211.56 / $4,379.39
| Professional | | $2,919.60 | $3,211.56 | $4,379.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,226.23 / $1,226.23 / $7,512.13
| Professional | | $1,226.23 | $1,226.23 | $7,512.13 |