- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,177.16 / $7,028.00 / $35,725.46
| Facility | | $1,177.16 | $7,028.00 | $35,725.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $903.30 / $1,618.17 / $11,063.38
| Professional | | $903.30 | $1,618.17 | $11,063.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,989.00 / $9,720.00 / $16,411.00
| Facility | | $4,989.00 | $9,720.00 | $16,411.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,564.53 / $6,602.78 / $15,500.22
| Professional | | $2,564.53 | $6,602.78 | $15,500.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.42 / $9,430.50 / $28,291.50
| Facility | | $1,078.42 | $9,430.50 | $28,291.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,078.42 / $1,078.42 / $8,928.19
| Professional | | $1,078.42 | $1,078.42 | $8,928.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,304.11 / $1,304.11 / $39,142.00
| Facility | | $1,304.11 | $1,304.11 | $39,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.59 / $3,587.48 / $20,193.98
| Professional | | $820.59 | $3,587.48 | $20,193.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.00 / $1,883.00 / $7,533.00
| Facility | | $332.00 | $1,883.00 | $7,533.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,675.82 / $7,272.37 / $10,910.19
| Professional | | $5,675.82 | $7,272.37 | $10,910.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.38 / $6,457.83 / $10,262.48
| Professional | | $949.38 | $6,457.83 | $10,262.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.00 / $5,700.00 / $39,142.00
| Facility | | $597.00 | $5,700.00 | $39,142.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $951.25 / $6,306.47 / $19,398.43
| Professional | | $951.25 | $6,306.47 | $19,398.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,964.00 / $9,202.00 / $20,879.00
| Facility | | $2,964.00 | $9,202.00 | $20,879.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,152.37 / $7,548.24 / $19,584.43
| Professional | | $4,152.37 | $7,548.24 | $19,584.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,018.43 / $1,018.43 / $3,858.70
| Facility | | $1,018.43 | $1,018.43 | $3,858.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.38 / $6,399.52 / $10,262.48
| Professional | | $949.38 | $6,399.52 | $10,262.48 |