- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,691.53 / $7,762.47
| Facility | | $2,089.30 | $2,691.53 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,041.74 / $5,128.61
| Professional | | $1,737.80 | $2,041.74 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,089.30 / $2,951.21
| Professional | | $1,698.24 | $2,089.30 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,691.53 / $3,311.31
| Professional | | $2,041.74 | $2,691.53 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,511.89
| Professional | | $32.36 | $33.11 | $2,511.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,630.27 / $6,606.93
| Facility | | $2,089.30 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $2,570.40 / $3,311.31
| Professional | | $1,995.26 | $2,570.40 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,090.30 / $5,128.61 / $19,498.45
| Facility | | $3,090.30 | $5,128.61 | $19,498.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,630.27 / $3,548.13
| Professional | | $1,949.84 | $2,630.27 | $3,548.13 |