- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,032.07 / $3,038.00 / $4,387.00
| Facility | | $3,032.07 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,032.07 / $3,032.07 / $5,823.09
| Professional | | $3,032.07 | $3,032.07 | $5,823.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,639.53 / $2,778.46 / $3,627.69
| Professional | | $2,639.53 | $2,778.46 | $3,627.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.26 / $1,382.78 / $1,888.08
| Professional | | $133.26 | $1,382.78 | $1,888.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,523.87 / $3,775.78 / $4,442.09
| Professional | | $2,523.87 | $3,775.78 | $4,442.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,312.00 / $2,446.00 / $13,847.00
| Facility | | $2,312.00 | $2,446.00 | $13,847.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,655.91 / $2,071.62 / $4,111.21
| Professional | | $1,655.91 | $2,071.62 | $4,111.21 |