- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $3,715.35 / $6,456.54
| Facility | | $2,570.40 | $3,715.35 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $691.83 / $1,778.28
| Professional | | $602.56 | $691.83 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,168.69 / $16,218.10
| Facility | | $56.23 | $4,168.69 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,000.00 / $5,011.87
| Professional | | $588.84 | $1,000.00 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,000.00 / $1,862.09
| Professional | | $575.44 | $1,000.00 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.00 / $1,047.13 / $8,511.38
| Facility | | $302.00 | $1,047.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $870.96 / $1,202.26
| Professional | | $691.83 | $870.96 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,918.31 / $15,488.17
| Facility | | $2,570.40 | $6,918.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,148.15 / $1,698.24
| Professional | | $630.96 | $1,148.15 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $56.23 / $4,168.69 / $16,218.10
| Facility | | $56.23 | $4,168.69 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $1,000.00 / $5,011.87
| Professional | | $588.84 | $1,000.00 | $5,011.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,570.40 / $6,165.95 / $14,125.38
| Facility | | $2,570.40 | $6,165.95 | $14,125.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $977.24 / $1,905.46
| Professional | | $660.69 | $977.24 | $1,905.46 |