- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,592.51 / $2,663.12 / $4,410.00
| Facility | | $1,592.51 | $2,663.12 | $4,410.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.71 / $1,592.51 / $3,501.91
| Professional | | $123.71 | $1,592.51 | $3,501.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $379.33 / $4,671.00 / $13,017.00
| Facility | | $379.33 | $4,671.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.26 / $2,684.00 / $6,842.34
| Professional | | $184.26 | $2,684.00 | $6,842.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.36 / $256.57 / $503.27
| Facility | | $197.36 | $256.57 | $503.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $278.77 / $1,097.09 / $3,559.59
| Professional | | $278.77 | $1,097.09 | $3,559.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.94 / $902.40 / $6,098.51
| Professional | | $305.94 | $902.40 | $6,098.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.14 / $269.89 / $6,679.00
| Facility | | $170.14 | $269.89 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,988.37 / $2,350.46 / $4,182.43
| Professional | | $1,988.37 | $2,350.46 | $4,182.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.27 / $1,938.64 / $4,828.38
| Professional | | $216.27 | $1,938.64 | $4,828.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,287.87 / $8,287.87 / $8,287.87
| Facility | | $8,287.87 | $8,287.87 | $8,287.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $332.94 / $2,581.75 / $5,475.62
| Professional | | $332.94 | $2,581.75 | $5,475.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $5,097.00 / $14,018.00
| Facility | | $55.00 | $5,097.00 | $14,018.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,674.70 / $4,508.29 / $11,282.72
| Professional | | $2,674.70 | $4,508.29 | $11,282.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,386.00 / $5,904.00 / $13,017.00
| Facility | | $2,386.00 | $5,904.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,297.63 / $3,005.79 / $6,007.62
| Professional | | $2,297.63 | $3,005.79 | $6,007.62 |