- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,255.83 / $7,920.26 / $20,680.40
| Facility | | $4,255.83 | $7,920.26 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,340.21 / $4,255.83 / $9,351.27
| Professional | | $3,340.21 | $4,255.83 | $9,351.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,550.39 / $100,337.38
| Facility | | $55.00 | $4,550.39 | $100,337.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,678.64 / $7,947.66 / $29,638.88
| Professional | | $4,678.64 | $7,947.66 | $29,638.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,241.71 / $6,683.25 / $9,948.04
| Professional | | $4,241.71 | $6,683.25 | $9,948.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,203.54 / $7,132.55 / $9,125.90
| Facility | | $3,203.54 | $7,132.55 | $9,125.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,175.24 / $7,280.12 / $9,159.15
| Professional | | $4,175.24 | $7,280.12 | $9,159.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.45 / $921.88 / $7,144.37
| Professional | | $234.45 | $921.88 | $7,144.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,142.47 / $6,367.13 / $7,111.38
| Facility | | $5,142.47 | $6,367.13 | $7,111.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,550.39 / $4,550.39 / $4,601.99
| Facility | | $4,550.39 | $4,550.39 | $4,601.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,815.14 / $7,639.44 / $9,143.43
| Professional | | $4,815.14 | $7,639.44 | $9,143.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,640.79 / $6,620.02 / $8,916.98
| Professional | | $4,640.79 | $6,620.02 | $8,916.98 |
- 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
- $4,383.72 / $6,216.46 / $9,693.61
| Professional | | $4,383.72 | $6,216.46 | $9,693.61 |