- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,737.80 / $7,943.28 / $20,892.96
| Facility | | $1,737.80 | $7,943.28 | $20,892.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,047.13 / $2,511.89
| Professional | | $851.14 | $1,047.13 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,230.27 / $8,317.64
| Facility | | $1,000.00 | $1,230.27 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $707.95 / $1,412.54 / $2,754.23
| Professional | | $707.95 | $1,412.54 | $2,754.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,905.46 / $7,079.46
| Facility | | $1,047.13 | $1,905.46 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,698.24 / $3,715.35
| Professional | | $851.14 | $1,698.24 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $416.87
| Professional | | $32.36 | $33.11 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,737.80 / $1,819.70
| Facility | | $1,318.26 | $1,737.80 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,258.93 / $4,168.69
| Facility | | $1,230.27 | $1,258.93 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,949.84 / $2,630.27
| Professional | | $1,258.93 | $1,949.84 | $2,630.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,964.78 / $16,595.87 / $31,622.78
| Facility | | $10,964.78 | $16,595.87 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,737.80 / $2,290.87
| Professional | | $1,380.38 | $1,737.80 | $2,290.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,884.03 / $17,378.01 / $33,113.11
| Facility | | $2,884.03 | $17,378.01 | $33,113.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $1,258.93 / $2,290.87
| Professional | | $831.76 | $1,258.93 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $977.24 / $1,621.81
| Professional | | $851.14 | $977.24 | $1,621.81 |