- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,158.83 / $2,747.00 / $6,305.39
| Facility | | $1,158.83 | $2,747.00 | $6,305.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.52 / $991.90 / $2,550.03
| Professional | | $243.52 | $991.90 | $2,550.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $737.68 / $3,245.00 / $7,608.00
| Facility | | $737.68 | $3,245.00 | $7,608.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.71 / $2,269.75 / $5,632.77
| Professional | | $354.71 | $2,269.75 | $5,632.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $380.52 / $494.68 / $970.33
| Facility | | $380.52 | $494.68 | $970.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $485.54 / $1,767.55 / $3,240.63
| Professional | | $485.54 | $1,767.55 | $3,240.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $521.28 / $1,949.88 / $4,281.71
| Professional | | $521.28 | $1,949.88 | $4,281.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $494.43 / $6,679.00
| Facility | | $214.32 | $494.43 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,780.67 / $2,102.42 / $3,759.00
| Professional | | $1,780.67 | $2,102.42 | $3,759.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.33 / $1,753.09 / $4,366.25
| Professional | | $415.33 | $1,753.09 | $4,366.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,912.88 / $6,041.09 / $10,199.08
| Facility | | $3,912.88 | $6,041.09 | $10,199.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.10 / $504.00 / $683.22
| Professional | | $142.10 | $504.00 | $683.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $4,287.00 / $9,401.00
| Facility | | $55.00 | $4,287.00 | $9,401.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,256.06 / $3,690.39 / $10,238.40
| Professional | | $2,256.06 | $3,690.39 | $10,238.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,155.00 / $5,268.00 / $9,700.98
| Facility | | $2,155.00 | $5,268.00 | $9,700.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,185.10 / $2,952.85 / $5,632.77
| Professional | | $2,185.10 | $2,952.85 | $5,632.77 |