- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,882.66 / $6,034.04 / $18,029.59
| Facility | | $1,882.66 | $6,034.04 | $18,029.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,368.06 / $2,083.46 / $2,133.67
| Professional | | $1,368.06 | $2,083.46 | $2,133.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $12,576.15
| Facility | | $244.00 | $614.00 | $12,576.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.00 / $376.96 / $592.79
| Professional | | $304.00 | $376.96 | $592.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $1,814.88 / $7,078.79
| Facility | | $92.60 | $1,814.88 | $7,078.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,142.15 / $1,631.64 / $4,079.92
| Professional | | $1,142.15 | $1,631.64 | $4,079.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,680.95 / $3,369.34 / $8,215.31
| Facility | | $1,680.95 | $3,369.34 | $8,215.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,886.74 / $3,388.78
| Professional | | $2,510.21 | $2,886.74 | $3,388.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,259.19 / $2,886.74 / $4,794.50
| Professional | | $2,259.19 | $2,886.74 | $4,794.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,367.77 / $11,923.50 / $11,923.50
| Facility | | $4,367.77 | $11,923.50 | $11,923.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12,500.85 / $12,500.85 / $18,826.58
| Professional | | $12,500.85 | $12,500.85 | $18,826.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,782.75 / $3,012.25 / $6,576.93
| Facility | | $1,782.75 | $3,012.25 | $6,576.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.21 / $2,761.23 / $3,765.32
| Professional | | $2,510.21 | $2,761.23 | $3,765.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,008.17 / $2,560.41 / $4,267.35
| Professional | | $2,008.17 | $2,560.41 | $4,267.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,054.29 / $1,142.15 / $6,741.67
| Professional | | $1,054.29 | $1,142.15 | $6,741.67 |