- 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
- $4,265.80 / $5,128.61 / $13,489.63
| Professional | | $4,265.80 | $5,128.61 | $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
- $4,365.16 / $6,606.93 / $33,113.11
| Professional | | $4,365.16 | $6,606.93 | $33,113.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.12 / $676.08 / $741.31
| Facility | | $50.12 | $676.08 | $741.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $6,309.57 / $12,882.50
| Professional | | $1,047.13 | $6,309.57 | $12,882.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $5,888.44 / $9,332.54
| Facility | | $302.00 | $5,888.44 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $6,309.57 / $8,912.51
| Professional | | $4,570.88 | $6,309.57 | $8,912.51 |
- 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
- $4,466.84 / $7,943.28 / $12,022.64
| Professional | | $4,466.84 | $7,943.28 | $12,022.64 |
- 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
- $4,365.16 / $6,606.93 / $33,113.11
| Professional | | $4,365.16 | $6,606.93 | $33,113.11 |
- 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
- $4,466.84 / $6,606.93 / $13,182.57
| Professional | | $4,466.84 | $6,606.93 | $13,182.57 |