- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,658.51 / $3,538.69 / $20,680.40
| Facility | | $1,658.51 | $3,538.69 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,146.34 / $1,658.51 / $3,538.69
| Professional | | $1,146.34 | $1,658.51 | $3,538.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,754.92 / $24,012.64
| Facility | | $55.00 | $1,754.92 | $24,012.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,789.79 / $3,033.79 / $11,932.00
| Professional | | $1,789.79 | $3,033.79 | $11,932.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,674.90 / $2,588.71 / $3,880.44
| Professional | | $1,674.90 | $2,588.71 | $3,880.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,238.76 / $2,737.48 / $3,329.17
| Facility | | $1,238.76 | $2,737.48 | $3,329.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,604.65 / $2,737.48 / $3,583.21
| Professional | | $1,604.65 | $2,737.48 | $3,583.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.06 / $1,526.41 / $2,938.64
| Professional | | $148.06 | $1,526.41 | $2,938.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,938.97 / $2,485.73 / $2,681.34
| Facility | | $1,938.97 | $2,485.73 | $2,681.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,754.92 / $1,754.92 / $1,785.50
| Facility | | $1,754.92 | $1,754.92 | $1,785.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,875.10 / $2,954.57 / $3,544.04
| Professional | | $1,875.10 | $2,954.57 | $3,544.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,789.79 / $2,568.46 / $3,459.65
| Professional | | $1,789.79 | $2,568.46 | $3,459.65 |
- 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
- $1,628.63 / $2,284.19 / $3,749.04
| Professional | | $1,628.63 | $2,284.19 | $3,749.04 |