- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,006.86 / $10,122.46 / $27,982.24
| Facility | | $2,006.86 | $10,122.46 | $27,982.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.75 / $1,659.91 / $2,064.05
| Professional | | $974.75 | $1,659.91 | $2,064.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $2,056.17 / $19,320.62
| Facility | | $55.00 | $2,056.17 | $19,320.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.02 / $3,562.77 / $13,241.18
| Professional | | $2,097.02 | $3,562.77 | $13,241.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,441.85 / $3,781.92 / $4,592.02
| Professional | | $2,441.85 | $3,781.92 | $4,592.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,406.47 / $3,065.28 / $3,773.47
| Facility | | $1,406.47 | $3,065.28 | $3,773.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,794.78 / $3,065.28 / $3,872.96
| Professional | | $1,794.78 | $3,065.28 | $3,872.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,250.55 / $1,407.69 / $1,563.19
| Facility | | $1,250.55 | $1,407.69 | $1,563.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,056.17 / $2,056.17 / $2,073.41
| Facility | | $2,056.17 | $2,056.17 | $2,073.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,134.19 / $3,441.55 / $4,119.10
| Professional | | $2,134.19 | $3,441.55 | $4,119.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,097.02 / $2,982.62 / $4,017.51
| Professional | | $2,097.02 | $2,982.62 | $4,017.51 |
- 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
- $1,820.27 / $2,507.92 / $4,064.79
| Professional | | $1,820.27 | $2,507.92 | $4,064.79 |