- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.07 / $22,489.50
| Facility | | $0.02 | $0.07 | $22,489.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.00 / $5,280.24 / $32,350.60
| Professional | | $2,000.00 | $5,280.24 | $32,350.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10.31 / $12,125.19 / $26,011.30
| Facility | | $10.31 | $12,125.19 | $26,011.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $2,352.09 / $4,528.08
| Professional | | $5.00 | $2,352.09 | $4,528.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,521.84 / $4,528.08 / $7,043.68
| Professional | | $3,521.84 | $4,528.08 | $7,043.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.00 / $5,031.20 / $5,031.20
| Facility | | $80.00 | $5,031.20 | $5,031.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,351.46 / $11,053.55 / $22,416.65
| Facility | | $3,351.46 | $11,053.55 | $22,416.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,549.64 / $4,779.67 / $7,920.73
| Professional | | $2,549.64 | $4,779.67 | $7,920.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,049.92 / $23,898.20 / $23,898.20
| Facility | | $8,049.92 | $23,898.20 | $23,898.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $25,156.00 / $25,156.00 / $37,734.00
| Professional | | $25,156.00 | $25,156.00 | $37,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,528.08 / $5,031.20 / $7,546.80
| Facility | | $4,528.08 | $5,031.20 | $7,546.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,031.20 / $5,031.20 / $6,289.00
| Professional | | $5,031.20 | $5,031.20 | $6,289.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,270.28 / $6,037.44 / $11,320.20
| Professional | | $3,270.28 | $6,037.44 | $11,320.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,519.03 / $6,540.56 / $21,284.99
| Facility | | $3,519.03 | $6,540.56 | $21,284.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,565.94 / $5,785.88 / $7,920.73
| Professional | | $2,565.94 | $5,785.88 | $7,920.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,113.10 / $2,113.10 / $3,018.72
| Professional | | $2,113.10 | $2,113.10 | $3,018.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $846.27 / $1,962.17 / $5,031.20
| Professional | | $846.27 | $1,962.17 | $5,031.20 |