- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $457.09 / $2,884.03 / $7,762.47
| Facility | | $457.09 | $2,884.03 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $363.08 / $954.99
| Professional | | $269.15 | $363.08 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,630.78 / $5,011.87
| Facility | | $1,819.70 | $3,630.78 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $398.11 / $1,000.00
| Professional | | $316.23 | $398.11 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $8,912.51
| Facility | | $426.58 | $426.58 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $537.03
| Professional | | $426.58 | $426.58 | $537.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $34.67 / $524.81 / $50,118.72
| Facility | | $34.67 | $524.81 | $50,118.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $660.69 / $1,445.44
| Professional | | $380.19 | $660.69 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $309.03 / $776.25
| Facility | | $100.00 | $309.03 | $776.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $575.44 / $794.33
| Professional | | $426.58 | $575.44 | $794.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $457.09 / $794.33
| Professional | | $263.03 | $457.09 | $794.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $354.81 / $50,118.72 / $75,857.76
| Facility | | $354.81 | $50,118.72 | $75,857.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $537.03 / $1,000.00
| Professional | | $467.74 | $537.03 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $912.01 / $2,754.23 / $4,897.79
| Facility | | $912.01 | $2,754.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $446.68 / $1,000.00
| Professional | | $309.03 | $446.68 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $331.13 / $1,023.29
| Facility | | $245.47 | $331.13 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.00 / $457.09 / $977.24
| Professional | | $302.00 | $457.09 | $977.24 |