- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $9,772.37 / $19,054.61
| Facility | | $2,454.71 | $9,772.37 | $19,054.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,454.71 / $2,884.03
| Professional | | $2,454.71 | $2,454.71 | $2,884.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,951.21 / $14,454.40
| Facility | | $1,995.26 | $2,951.21 | $14,454.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.30 / $2,818.38 / $5,370.32
| Professional | | $26.30 | $2,818.38 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $3,162.28
| Professional | | $2,089.30 | $2,089.30 | $3,162.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,089.30 / $3,548.13
| Facility | | $1,348.96 | $2,089.30 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,479.11 / $3,548.13
| Professional | | $1,230.27 | $1,479.11 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,089.30 / $3,548.13
| Professional | | $2,089.30 | $2,089.30 | $3,548.13 |