- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.31 / $7,244.36 / $16,595.87
| Facility | | $741.31 | $7,244.36 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $436.52 / $1,000.00
| Professional | | $323.59 | $436.52 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $794.33 / $1,148.15
| Professional | | $416.87 | $794.33 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $691.83 / $912.01
| Professional | | $537.03 | $691.83 | $912.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.52 / $676.08 / $9,549.93
| Facility | | $436.52 | $676.08 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $645.65 / $977.24
| Professional | | $549.54 | $645.65 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $691.83 / $758.58
| Facility | | $549.54 | $691.83 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $398.11 / $524.81 / $891.25
| Facility | | $398.11 | $524.81 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $707.95 / $1,000.00
| Professional | | $79.43 | $707.95 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,489.63 / $18,197.01 / $21,877.62
| Facility | | $13,489.63 | $18,197.01 | $21,877.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $812.83 / $1,023.29
| Professional | | $691.83 | $812.83 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $20,892.96 / $26,302.68
| Facility | | $3,019.95 | $20,892.96 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $707.95 / $1,023.29
| Professional | | $457.09 | $707.95 | $1,023.29 |