- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,428.58 / $4,923.14 / $20,680.40
| Facility | | $2,428.58 | $4,923.14 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,802.55 / $2,428.58 / $5,005.62
| Professional | | $1,802.55 | $2,428.58 | $5,005.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,589.80 / $57,231.98
| Facility | | $55.00 | $2,589.80 | $57,231.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,700.10 / $4,536.09 / $22,284.20
| Professional | | $2,700.10 | $4,536.09 | $22,284.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,415.92 / $3,808.24 / $5,679.11
| Professional | | $2,415.92 | $3,808.24 | $5,679.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,876.12 / $4,062.17 / $4,933.43
| Facility | | $1,876.12 | $4,062.17 | $4,933.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,377.91 / $4,146.22 / $5,286.94
| Professional | | $2,377.91 | $4,146.22 | $5,286.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.67 / $502.09 / $4,036.07
| Professional | | $130.67 | $502.09 | $4,036.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,896.70 / $3,634.87 / $3,887.56
| Facility | | $2,896.70 | $3,634.87 | $3,887.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,589.80 / $2,589.80 / $2,623.18
| Facility | | $2,589.80 | $2,589.80 | $2,623.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,761.22 / $4,350.83 / $5,207.38
| Professional | | $2,761.22 | $4,350.83 | $5,207.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,641.25 / $3,773.48 / $5,082.77
| Professional | | $2,641.25 | $3,773.48 | $5,082.77 |
- 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
- $2,433.48 / $3,786.16 / $5,520.73
| Professional | | $2,433.48 | $3,786.16 | $5,520.73 |