- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,817.42 / $3,817.42 / $70,106.89
| Facility | | $3,817.42 | $3,817.42 | $70,106.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,645.92 / $3,817.42 / $70,106.89
| Professional | | $2,645.92 | $3,817.42 | $70,106.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,751.00 / $10,099.00 / $20,369.00
| Facility | | $3,751.00 | $10,099.00 | $20,369.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,001.10 / $11,704.55 / $28,882.91
| Professional | | $1,001.10 | $11,704.55 | $28,882.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,062.37 / $7,921.48 / $18,196.40
| Facility | | $4,062.37 | $7,921.48 | $18,196.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $773.45 / $5,123.32 / $21,900.70
| Professional | | $773.45 | $5,123.32 | $21,900.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,034.81 / $1,492.43 / $20,700.43
| Professional | | $1,034.81 | $1,492.43 | $20,700.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.55 / $829.33 / $15,147.68
| Professional | | $594.55 | $829.33 | $15,147.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.58 / $5,548.00 / $15,147.68
| Professional | | $662.58 | $5,548.00 | $15,147.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $15,257.13 / $15,257.13
| Facility | | $55.00 | $15,257.13 | $15,257.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31,394.63 / $60,798.81 / $70,647.60
| Professional | | $31,394.63 | $60,798.81 | $70,647.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.56 / $1,646.04 / $14,747.19
| Facility | | $756.56 | $1,646.04 | $14,747.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $662.58 / $1,979.53 / $25,263.12
| Professional | | $662.58 | $1,979.53 | $25,263.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,215.46 / $2,215.46 / $34,603.85
| Professional | | $2,215.46 | $2,215.46 | $34,603.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.55 / $772.93 / $12,478.39
| Professional | | $594.55 | $772.93 | $12,478.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $21,566.24 / $33,546.07 / $33,546.07
| Facility | | $21,566.24 | $33,546.07 | $33,546.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,113.03 / $11,010.45 / $27,451.05
| Professional | | $8,113.03 | $11,010.45 | $27,451.05 |