- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,715.35 / $5,623.41
| Facility | | $2,691.53 | $3,715.35 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $5,370.32 / $13,489.63
| Professional | | $4,570.88 | $5,370.32 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,754.23 / $43,651.58
| Facility | | $56.23 | $2,754.23 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,918.31 / $33,884.42
| Professional | | $3,548.13 | $6,918.31 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $741.31 / $1,380.38
| Facility | | $50.12 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $6,606.93 / $13,489.63
| Professional | | $1,258.93 | $6,606.93 | $13,489.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $5,888.44 / $9,549.93
| Facility | | $302.00 | $5,888.44 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,786.30 / $6,606.93 / $9,772.37
| Professional | | $4,786.30 | $6,606.93 | $9,772.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $2,454.71 / $4,677.35
| Facility | | $295.12 | $2,454.71 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,677.35 / $8,317.64 / $12,589.25
| Professional | | $4,677.35 | $8,317.64 | $12,589.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $2,754.23 / $43,651.58
| Facility | | $56.23 | $2,754.23 | $43,651.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,548.13 / $6,918.31 / $33,884.42
| Professional | | $3,548.13 | $6,918.31 | $33,884.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.33 / $2,754.23 / $4,677.35
| Facility | | $794.33 | $2,754.23 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $6,918.31 / $13,489.63
| Professional | | $3,235.94 | $6,918.31 | $13,489.63 |