- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,648.76 / $5,743.94 / $15,789.70
| Facility | | $1,648.76 | $5,743.94 | $15,789.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.09 / $1,824.63 / $1,868.60
| Professional | | $1,198.09 | $1,824.63 | $1,868.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.00 / $614.00 / $11,013.73
| Facility | | $244.00 | $614.00 | $11,013.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.79 / $617.76 / $3,605.29
| Professional | | $514.79 | $617.76 | $3,605.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $92.60 / $1,589.41 / $6,199.35
| Facility | | $92.60 | $1,589.41 | $6,199.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.25 / $1,428.93 / $3,573.04
| Professional | | $1,000.25 | $1,428.93 | $3,573.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.12 / $2,950.74 / $7,194.66
| Facility | | $1,472.12 | $2,950.74 | $7,194.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,198.35 / $2,418.19 / $2,967.77
| Professional | | $2,198.35 | $2,418.19 | $2,967.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,978.52 / $2,528.10 / $4,198.85
| Professional | | $1,978.52 | $2,528.10 | $4,198.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,825.13 / $10,442.16 / $10,442.16
| Facility | | $3,825.13 | $10,442.16 | $10,442.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10,947.78 / $10,947.78 / $16,487.63
| Professional | | $10,947.78 | $10,947.78 | $16,487.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,758.68 / $2,638.02 / $5,759.90
| Facility | | $1,758.68 | $2,638.02 | $5,759.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,198.35 / $2,418.19 / $3,297.53
| Professional | | $2,198.35 | $2,418.19 | $3,297.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,758.68 / $2,242.32 / $3,737.20
| Professional | | $1,758.68 | $2,242.32 | $3,737.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.31 / $932.10 / $4,874.62
| Professional | | $923.31 | $932.10 | $4,874.62 |