- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,230.13 / $3,166.24 / $7,172.21
| Facility | | $2,230.13 | $3,166.24 | $7,172.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $455.43 / $2,120.00 / $2,312.73
| Professional | | $455.43 | $2,120.00 | $2,312.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.81 / $3,854.55 / $10,737.68
| Facility | | $894.81 | $3,854.55 | $10,737.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.00 / $237.12 / $2,753.25
| Professional | | $208.00 | $237.12 | $2,753.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,457.13 / $4,652.99 / $8,259.04
| Facility | | $2,457.13 | $4,652.99 | $8,259.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,303.90 / $3,353.83 / $4,018.27
| Professional | | $3,303.90 | $3,353.83 | $4,018.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,514.29 / $1,514.29 / $2,753.00
| Facility | | $1,514.29 | $1,514.29 | $2,753.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,156.36 / $1,651.95 / $3,166.24
| Professional | | $1,156.36 | $1,651.95 | $3,166.24 |