- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,432.33 / $6,470.00 / $20,680.40
| Facility | | $3,432.33 | $6,470.00 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,413.44 / $3,432.33 / $6,993.54
| Professional | | $2,413.44 | $3,432.33 | $6,993.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,652.09 / $80,837.12
| Facility | | $55.00 | $3,652.09 | $80,837.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,811.18 / $6,398.76 / $28,429.64
| Professional | | $3,811.18 | $6,398.76 | $28,429.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,371.45 / $5,378.03 / $8,028.99
| Professional | | $3,371.45 | $5,378.03 | $8,028.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,554.09 / $5,609.29 / $6,884.62
| Facility | | $2,554.09 | $5,609.29 | $6,884.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,318.38 / $5,609.29 / $7,295.47
| Professional | | $3,318.38 | $5,609.29 | $7,295.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.18 / $725.29 / $5,783.42
| Professional | | $179.18 | $725.29 | $5,783.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,974.77 / $5,136.04 / $5,482.16
| Facility | | $3,974.77 | $5,136.04 | $5,482.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,652.09 / $3,652.09 / $3,702.61
| Facility | | $3,652.09 | $3,652.09 | $3,702.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,830.50 / $6,137.42 / $7,349.32
| Professional | | $3,830.50 | $6,137.42 | $7,349.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,724.64 / $5,326.25 / $7,174.32
| Professional | | $3,724.64 | $5,326.25 | $7,174.32 |
- 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
- $3,488.32 / $4,756.80 / $7,787.72
| Professional | | $3,488.32 | $4,756.80 | $7,787.72 |