- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,949.84 / $3,630.78 / $5,623.41
| Facility | | $1,949.84 | $3,630.78 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $676.08 / $1,778.28
| Professional | | $575.44 | $676.08 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,479.11 / $5,623.41 / $33,884.42
| Facility | | $1,479.11 | $5,623.41 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,000.00 / $6,025.60
| Professional | | $602.56 | $1,000.00 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,000.00 / $1,819.70
| Professional | | $645.65 | $1,000.00 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.60 / $1,348.96 / $7,079.46
| Facility | | $616.60 | $1,348.96 | $7,079.46 |
- 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
- $2,137.96 / $5,248.07 / $11,220.18
| Facility | | $2,137.96 | $5,248.07 | $11,220.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,174.90 / $1,862.09
| Professional | | $630.96 | $1,174.90 | $1,862.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,548.82 / $5,623.41 / $33,884.42
| Facility | | $1,548.82 | $5,623.41 | $33,884.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $1,000.00 / $6,025.60
| Professional | | $602.56 | $1,000.00 | $6,025.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $5,248.07 / $10,715.19
| Facility | | $2,041.74 | $5,248.07 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,000.00 / $1,905.46
| Professional | | $676.08 | $1,000.00 | $1,905.46 |