- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,940.82 / $5,846.06 / $20,680.40
| Facility | | $2,940.82 | $5,846.06 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,251.56 / $2,940.82 / $5,920.79
| Professional | | $1,251.56 | $2,940.82 | $5,920.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,130.68 / $42,530.72
| Facility | | $55.00 | $3,130.68 | $42,530.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,192.88 / $5,474.56 / $20,428.28
| Professional | | $3,192.88 | $5,474.56 | $20,428.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,760.15 / $4,608.03 / $6,873.28
| Professional | | $2,760.15 | $4,608.03 | $6,873.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,175.58 / $3,859.90 / $5,850.04
| Facility | | $2,175.58 | $3,859.90 | $5,850.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,819.71 / $4,070.44 / $6,117.93
| Professional | | $2,819.71 | $4,070.44 | $6,117.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.18 / $644.32 / $4,943.08
| Professional | | $179.18 | $644.32 | $4,943.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.61 / $4,401.92 / $4,643.10
| Facility | | $2,398.61 | $4,401.92 | $4,643.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,130.68 / $3,130.68 / $3,167.01
| Facility | | $3,130.68 | $3,130.68 | $3,167.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,259.87 / $5,250.97 / $6,286.20
| Professional | | $3,259.87 | $5,250.97 | $6,286.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,192.88 / $4,555.78 / $6,136.52
| Professional | | $3,192.88 | $4,555.78 | $6,136.52 |
- 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
- $2,443.27 / $3,795.55 / $6,662.93
| Professional | | $2,443.27 | $3,795.55 | $6,662.93 |