- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,951.37 / $10,550.00 / $22,788.00
| Facility | | $3,951.37 | $10,550.00 | $22,788.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $804.48 / $855.65 / $1,098.83
| Professional | | $804.48 | $855.65 | $1,098.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,537.00 / $7,764.00 / $17,702.00
| Facility | | $3,537.00 | $7,764.00 | $17,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.41 / $854.83 / $3,172.03
| Professional | | $337.41 | $854.83 | $3,172.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $66.09 / $100.00 / $7,323.06
| Facility | | $66.09 | $100.00 | $7,323.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $709.33 / $1,013.33 / $2,034.77
| Professional | | $709.33 | $1,013.33 | $2,034.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $18,183.00 / $32,827.67 / $38,796.33
| Facility | | $18,183.00 | $32,827.67 | $38,796.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.52 / $708.67 / $826.43
| Professional | | $676.52 | $708.67 | $826.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36,433.32 / $36,433.32 / $38,254.99
| Professional | | $36,433.32 | $36,433.32 | $38,254.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.25 / $1,085.76 / $1,785.48
| Professional | | $945.25 | $1,085.76 | $1,785.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,900.85 / $147,391.15 / $147,391.15
| Facility | | $3,900.85 | $147,391.15 | $147,391.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,024.96 / $6,454.32 / $7,191.23
| Professional | | $6,024.96 | $6,454.32 | $7,191.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $987.05 / $1,260.33 / $1,674.16
| Facility | | $987.05 | $1,260.33 | $1,674.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $687.88 / $985.00 / $1,260.33
| Professional | | $687.88 | $985.00 | $1,260.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17,643.00 / $36,665.00 / $81,823.00
| Facility | | $17,643.00 | $36,665.00 | $81,823.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $734.16 / $1,088.72 / $2,250.30
| Professional | | $734.16 | $1,088.72 | $2,250.30 |