- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,951.55 / $4,001.36 / $20,680.40
| Facility | | $1,951.55 | $4,001.36 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,438.41 / $1,951.55 / $4,001.36
| Professional | | $1,438.41 | $1,951.55 | $4,001.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,077.46 / $37,008.30
| Facility | | $55.00 | $2,077.46 | $37,008.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,118.73 / $3,558.70 / $18,154.00
| Professional | | $2,118.73 | $3,558.70 | $18,154.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,062.44 / $3,059.71 / $4,549.17
| Professional | | $2,062.44 | $3,059.71 | $4,549.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,470.02 / $3,261.05 / $3,960.48
| Facility | | $1,470.02 | $3,261.05 | $3,960.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,908.95 / $3,328.52 / $4,251.52
| Professional | | $1,908.95 | $3,328.52 | $4,251.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.09 / $443.78 / $3,281.72
| Professional | | $120.09 | $443.78 | $3,281.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,233.91 / $2,922.61 / $3,118.48
| Facility | | $2,233.91 | $2,922.61 | $3,118.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,077.46 / $2,077.46 / $2,094.42
| Facility | | $2,077.46 | $2,077.46 | $2,094.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,209.27 / $3,481.12 / $4,166.45
| Professional | | $2,209.27 | $3,481.12 | $4,166.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,118.73 / $3,012.87 / $4,058.25
| Professional | | $2,118.73 | $3,012.87 | $4,058.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,120.00 / $3,323.00 / $36,803.00
| Facility | | $1,120.00 | $3,323.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,937.47 / $2,802.41 / $4,417.17
| Professional | | $1,937.47 | $2,802.41 | $4,417.17 |