- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,524.21 / $7,871.30 / $15,375.33
| Facility | | $2,524.21 | $7,871.30 | $15,375.33 |
- Facility/Professional
- Facility
- Modifier
- 22
- Low / Median / High Price
- $10,120.64 / $10,120.64 / $10,120.64
| Facility | 22 | $10,120.64 | $10,120.64 | $10,120.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $931.51 / $1,369.25 / $4,475.00
| Professional | | $931.51 | $1,369.25 | $4,475.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,407.00 / $14,301.82 / $19,497.00
| Facility | | $8,407.00 | $14,301.82 | $19,497.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $983.19 / $2,077.96 / $2,900.41
| Professional | | $983.19 | $2,077.96 | $2,900.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $9,619.46 / $9,619.46
| Facility | | $1,185.00 | $9,619.46 | $9,619.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,434.53 / $1,922.79 / $2,758.94
| Professional | | $1,434.53 | $1,922.79 | $2,758.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,262.95 / $8,988.00 / $9,171.00
| Facility | | $7,262.95 | $8,988.00 | $9,171.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $926.47 / $1,943.95 / $6,293.00
| Professional | | $926.47 | $1,943.95 | $6,293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,961.29 / $4,240.57 / $10,218.58
| Facility | | $2,961.29 | $4,240.57 | $10,218.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.41 / $970.80 / $2,564.88
| Professional | | $135.41 | $970.80 | $2,564.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,943.00 / $10,348.00 / $18,470.00
| Facility | | $6,943.00 | $10,348.00 | $18,470.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $953.82 / $1,907.65 / $3,256.54
| Professional | | $953.82 | $1,907.65 | $3,256.54 |