- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,318.67 / $10,321.00 / $22,788.00
| Facility | | $2,318.67 | $10,321.00 | $22,788.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,940.26 / $2,318.67 / $12,523.90
| Professional | | $1,940.26 | $2,318.67 | $12,523.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,540.00 / $13,419.17 / $28,633.72
| Facility | | $5,540.00 | $13,419.17 | $28,633.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,130.62 / $4,093.45 / $7,579.22
| Professional | | $3,130.62 | $4,093.45 | $7,579.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.50 / $100.00 / $10,373.42
| Facility | | $63.50 | $100.00 | $10,373.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,652.40 / $2,566.51 / $6,250.32
| Professional | | $1,652.40 | $2,566.51 | $6,250.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,318.92 / $3,085.65 / $8,115.01
| Professional | | $2,318.92 | $3,085.65 | $8,115.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,860.76 / $2,642.98 / $3,171.58
| Professional | | $1,860.76 | $2,642.98 | $3,171.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,402.82 / $3,139.05 / $5,559.71
| Professional | | $2,402.82 | $3,139.05 | $5,559.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $28,566.24 / $34,547.16
| Facility | | $55.00 | $28,566.24 | $34,547.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17,488.43 / $17,676.64 / $22,515.83
| Professional | | $17,488.43 | $17,676.64 | $22,515.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,446.33 / $3,013.49 / $4,228.77
| Facility | | $2,446.33 | $3,013.49 | $4,228.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,303.50 / $3,220.74 / $6,844.28
| Professional | | $2,303.50 | $3,220.74 | $6,844.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,770.84 / $7,770.84 / $7,770.84
| Professional | | $7,770.84 | $7,770.84 | $7,770.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,860.76 / $2,791.13 / $3,519.84
| Professional | | $1,860.76 | $2,791.13 | $3,519.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,009.00 / $5,159.00 / $20,279.00
| Facility | | $2,009.00 | $5,159.00 | $20,279.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,027.07 / $2,825.54 / $8,027.67
| Professional | | $2,027.07 | $2,825.54 | $8,027.67 |