- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,592.48 / $7,138.25 / $20,680.40
| Facility | | $3,592.48 | $7,138.25 | $20,680.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,455.39 / $3,592.48 / $7,142.16
| Professional | | $2,455.39 | $3,592.48 | $7,142.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $3,874.51 / $39,477.00
| Facility | | $55.00 | $3,874.51 | $39,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,021.11 / $7,137.91 / $26,141.25
| Professional | | $4,021.11 | $7,137.91 | $26,141.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,526.53 / $5,711.26 / $8,575.54
| Professional | | $3,526.53 | $5,711.26 | $8,575.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,362.65 / $5,400.23 / $7,197.20
| Facility | | $3,362.65 | $5,400.23 | $7,197.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,469.04 / $5,461.07 / $7,233.17
| Professional | | $3,469.04 | $5,461.07 | $7,233.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.58 / $1,044.18 / $6,092.48
| Professional | | $319.58 | $1,044.18 | $6,092.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,942.54 / $5,400.35 / $5,800.19
| Facility | | $3,942.54 | $5,400.35 | $5,800.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,874.51 / $3,874.51 / $3,956.25
| Facility | | $3,874.51 | $3,874.51 | $3,956.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,072.25 / $6,599.23 / $8,114.21
| Professional | | $4,072.25 | $6,599.23 | $8,114.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,951.49 / $5,691.11 / $7,665.77
| Professional | | $3,951.49 | $5,691.11 | $7,665.77 |
- 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
- $3,537.51 / $6,084.33 / $8,331.31
| Professional | | $3,537.51 | $6,084.33 | $8,331.31 |