- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $768.00 / $5,342.00 / $23,456.20
| Facility | | $768.00 | $5,342.00 | $23,456.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.47 / $1,964.84 / $11,855.79
| Professional | | $568.47 | $1,964.84 | $11,855.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $801.21 / $801.21 / $801.21
| Professional | | $801.21 | $801.21 | $801.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,531.00 / $27,840.00 / $57,255.43
| Facility | | $13,531.00 | $27,840.00 | $57,255.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6,822.10 / $13,565.85 / $17,475.68
| Professional | | $6,822.10 | $13,565.85 | $17,475.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $620.04 / $1,251.90 / $15,124.65
| Professional | | $620.04 | $1,251.90 | $15,124.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,709.44 / $12,709.44 / $13,257.58
| Professional | | $12,709.44 | $12,709.44 | $13,257.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,041.29 / $25,424.04 / $54,655.67
| Facility | | $6,041.29 | $25,424.04 | $54,655.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $832.00 / $5,342.00 / $23,456.20
| Facility | | $832.00 | $5,342.00 | $23,456.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $568.47 / $1,852.40 / $14,501.10
| Professional | | $568.47 | $1,852.40 | $14,501.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $6.00 / $11,025.20 / $24,989.70
| Professional | | $6.00 | $11,025.20 | $24,989.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $629.91 / $1,272.45 / $15,124.65
| Professional | | $629.91 | $1,272.45 | $15,124.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.23 / $670.45 / $10,027.27
| Facility | | $541.23 | $670.45 | $10,027.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.23 / $670.45 / $9,081.67
| Professional | | $541.23 | $670.45 | $9,081.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,340.00 / $7,000.00 / $12,076.00
| Facility | | $3,340.00 | $7,000.00 | $12,076.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,886.04 / $11,598.65 / $18,319.93
| Professional | | $8,886.04 | $11,598.65 | $18,319.93 |