- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,339.89 / $4,582.07 / $8,077.38
| Facility | | $1,339.89 | $4,582.07 | $8,077.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,050.90 / $1,050.90 / $1,084.44
| Professional | | $1,050.90 | $1,050.90 | $1,084.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $5,601.03
| Facility | | $244.00 | $614.00 | $5,601.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.33 / $399.04 / $870.38
| Professional | | $335.33 | $399.04 | $870.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.40 / $1,475.73 / $10,028.28
| Facility | | $59.40 | $1,475.73 | $10,028.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $793.50 / $1,133.57 / $2,849.68
| Professional | | $793.50 | $1,133.57 | $2,849.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,046.43 / $2,289.81 / $5,707.52
| Facility | | $1,046.43 | $2,289.81 | $5,707.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.95 / $2,092.73 / $2,790.32
| Professional | | $1,743.95 | $2,092.73 | $2,790.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,569.56 / $2,005.54 / $3,330.94
| Professional | | $1,569.56 | $2,005.54 | $3,330.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,034.47 / $8,283.76 / $8,283.76
| Facility | | $3,034.47 | $8,283.76 | $8,283.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,684.87 / $8,684.87 / $13,079.63
| Professional | | $8,684.87 | $8,684.87 | $13,079.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,084.44 / $2,092.73 / $4,569.10
| Facility | | $1,084.44 | $2,092.73 | $4,569.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,743.95 / $1,918.35 / $2,615.92
| Professional | | $1,743.95 | $1,918.35 | $2,615.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,117.98 / $1,117.98 / $1,117.98
| Professional | | $1,117.98 | $1,117.98 | $1,117.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.55 / $508.68 / $2,876.56
| Professional | | $469.55 | $508.68 | $2,876.56 |