- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,469.82 / $3,353.90 / $20,680.40
| Facility | | $1,469.82 | $3,353.90 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $990.38 / $1,469.82 / $3,050.09
| Professional | | $990.38 | $1,469.82 | $3,050.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $1,523.44 / $10,711.76
| Facility | | $55.00 | $1,523.44 | $10,711.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,636.07 / $2,802.55 / $9,760.65
| Professional | | $1,636.07 | $2,802.55 | $9,760.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,437.11 / $2,347.96 / $3,455.28
| Professional | | $1,437.11 | $2,347.96 | $3,455.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,357.51 / $2,416.42 / $2,934.70
| Facility | | $1,357.51 | $2,416.42 | $2,934.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,414.52 / $2,416.42 / $2,934.70
| Professional | | $1,414.52 | $2,416.42 | $2,934.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.40 / $1,409.04 / $2,697.51
| Professional | | $150.40 | $1,409.04 | $2,697.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,644.39 / $2,191.57 / $2,296.76
| Facility | | $1,644.39 | $2,191.57 | $2,296.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,523.44 / $1,523.44 / $1,566.60
| Facility | | $1,523.44 | $1,523.44 | $1,566.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,612.53 / $2,613.16 / $3,213.06
| Professional | | $1,612.53 | $2,613.16 | $3,213.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,553.71 / $2,253.36 / $3,035.49
| Professional | | $1,553.71 | $2,253.36 | $3,035.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $703.00 / $2,446.00 / $36,803.00
| Facility | | $703.00 | $2,446.00 | $36,803.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,471.50 / $2,331.69 / $3,437.14
| Professional | | $1,471.50 | $2,331.69 | $3,437.14 |