- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $727.66 / $6,732.07 / $21,863.94
| Facility | | $727.66 | $6,732.07 | $21,863.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.42 / $498.94 / $2,023.97
| Professional | | $299.42 | $498.94 | $2,023.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.02 / $640.03 / $1,186.41
| Professional | | $320.02 | $640.03 | $1,186.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,712.35 / $6,198.03 / $11,988.99
| Facility | | $4,712.35 | $6,198.03 | $11,988.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.97 / $706.50 / $1,026.24
| Professional | | $384.97 | $706.50 | $1,026.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,368.73 / $2,368.73 / $2,368.73
| Facility | | $2,368.73 | $2,368.73 | $2,368.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $546.17 / $1,053.09 / $1,565.02
| Professional | | $546.17 | $1,053.09 | $1,565.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.86 / $823.25 / $4,038.98
| Facility | | $448.86 | $823.25 | $4,038.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $614.54 / $1,001.34 / $2,928.16
| Professional | | $614.54 | $1,001.34 | $2,928.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $826.17 / $1,181.95 / $2,842.49
| Facility | | $826.17 | $1,181.95 | $2,842.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $755.00 / $1,013.62 / $1,436.38
| Professional | | $755.00 | $1,013.62 | $1,436.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.02 / $725.36 / $1,091.03
| Professional | | $416.02 | $725.36 | $1,091.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $6,451.00 / $7,934.00
| Facility | | $4,217.00 | $6,451.00 | $7,934.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $667.56 / $1,114.63 / $1,437.83
| Professional | | $667.56 | $1,114.63 | $1,437.83 |