- 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
- $616.60 / $707.95 / $1,621.81
| Professional | | $616.60 | $707.95 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,677.35 / $25,703.96
| Facility | | $1,698.24 | $4,677.35 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $4,677.35
| Professional | | $660.69 | $1,000.00 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,288.25 / $1,778.28
| Professional | | $870.96 | $1,288.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $741.31 / $15,488.17
| Facility | | $676.08 | $741.31 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $1,778.28
| Professional | | $524.81 | $891.25 | $1,778.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,348.96 / $7,079.46
| Facility | | $575.44 | $1,348.96 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $912.01 / $1,380.38
| Professional | | $660.69 | $912.01 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $5,888.44 / $15,488.17
| Facility | | $851.14 | $5,888.44 | $15,488.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,174.90 / $1,819.70
| Professional | | $645.65 | $1,174.90 | $1,819.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $4,677.35 / $25,703.96
| Facility | | $1,698.24 | $4,677.35 | $25,703.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $1,000.00 / $4,677.35
| Professional | | $660.69 | $1,000.00 | $4,677.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $6,025.60 / $16,595.87
| Facility | | $1,698.24 | $6,025.60 | $16,595.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $1,000.00 / $1,905.46
| Professional | | $645.65 | $1,000.00 | $1,905.46 |