- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,083.93 / $3,111.85 / $8,271.00
| Facility | | $1,083.93 | $3,111.85 | $8,271.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.78 / $1,083.93 / $2,291.19
| Professional | | $206.78 | $1,083.93 | $2,291.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $631.57 / $4,671.00 / $13,017.00
| Facility | | $631.57 | $4,671.00 | $13,017.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.52 / $2,037.64 / $5,377.34
| Professional | | $304.52 | $2,037.64 | $5,377.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $325.95 / $423.75 / $831.20
| Facility | | $325.95 | $423.75 | $831.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.06 / $1,586.01 / $3,293.67
| Professional | | $469.06 | $1,586.01 | $3,293.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $447.84 / $1,749.61 / $3,876.71
| Professional | | $447.84 | $1,749.61 | $3,876.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.32 / $423.16 / $6,679.00
| Facility | | $214.32 | $423.16 | $6,679.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,597.79 / $1,884.86 / $3,369.99
| Professional | | $1,597.79 | $1,884.86 | $3,369.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $355.53 / $1,570.82 / $3,912.28
| Professional | | $355.53 | $1,570.82 | $3,912.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,134.04 / $1,134.04 / $6,238.21
| Facility | | $1,134.04 | $1,134.04 | $6,238.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $226.63 / $292.95 / $594.00
| Professional | | $226.63 | $292.95 | $594.00 |
- 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
- $2,024.34 / $3,354.48 / $9,169.20
| Professional | | $2,024.34 | $3,354.48 | $9,169.20 |
- 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
- $1,805.69 / $2,379.66 / $4,374.51
| Professional | | $1,805.69 | $2,379.66 | $4,374.51 |