- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,951.21 / $6,918.31 / $6,918.31
| Facility | | $2,951.21 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,995.26 / $2,630.27
| Professional | | $1,737.80 | $1,995.26 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $354.81 / $7,244.36
| Professional | | $302.00 | $354.81 | $7,244.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $7,943.28 / $12,882.50
| Facility | | $6,918.31 | $7,943.28 | $12,882.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $3,715.35 / $7,762.47
| Professional | | $2,884.03 | $3,715.35 | $7,762.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $8,511.38 / $14,454.40
| Facility | | $1,479.11 | $8,511.38 | $14,454.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $2,344.23 / $11,748.98
| Facility | | $1,479.11 | $2,344.23 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,479.11 / $4,466.84
| Professional | | $1,230.27 | $1,479.11 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.12 / $54.95 / $85.11
| Professional | | $50.12 | $54.95 | $85.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $5,754.40 / $8,128.31
| Professional | | $3,235.94 | $5,754.40 | $8,128.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,011.87 / $5,011.87 / $11,748.98
| Facility | | $5,011.87 | $5,011.87 | $11,748.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5,248.07 / $5,248.07 / $5,248.07
| Professional | | $5,248.07 | $5,248.07 | $5,248.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,244.36 / $13,489.63 / $19,054.61
| Professional | | $7,244.36 | $13,489.63 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $1,995.26 / $3,019.95
| Facility | | $1,995.26 | $1,995.26 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,479.11 / $4,786.30
| Professional | | $1,047.13 | $1,479.11 | $4,786.30 |