- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,426.22 / $10,122.46 / $27,982.24
| Facility | | $3,426.22 | $10,122.46 | $27,982.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,224.76 / $3,426.22 / $4,403.51
| Professional | | $3,224.76 | $3,426.22 | $4,403.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,511.20 / $66,811.71
| Facility | | $55.00 | $3,511.20 | $66,811.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,580.96 / $6,430.62 / $23,983.28
| Professional | | $3,580.96 | $6,430.62 | $23,983.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,183.57 / $6,389.85 / $7,867.41
| Professional | | $4,183.57 | $6,389.85 | $7,867.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,124.00 / $5,447.14 / $9,101.20
| Facility | | $3,124.00 | $5,447.14 | $9,101.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,199.20 / $5,633.37 / $9,101.20
| Professional | | $3,199.20 | $5,633.37 | $9,101.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $50.00 / $50.00
| Professional | | $45.00 | $50.00 | $50.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,473.23 / $5,079.51 / $5,506.06
| Facility | | $3,473.23 | $5,079.51 | $5,506.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,511.20 / $3,511.20 / $3,552.26
| Facility | | $3,511.20 | $3,511.20 | $3,552.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,656.42 / $5,895.45 / $7,056.10
| Professional | | $3,656.42 | $5,895.45 | $7,056.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,580.96 / $5,710.57 / $7,773.80
| Professional | | $3,580.96 | $5,710.57 | $7,773.80 |
- 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
- $3,026.21 / $4,350.16 / $7,360.60
| Professional | | $3,026.21 | $4,350.16 | $7,360.60 |