- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,450.03 / $3,038.00 / $4,387.00
| Facility | | $2,450.03 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,768.71 / $2,450.03 / $5,778.86
| Professional | | $1,768.71 | $2,450.03 | $5,778.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,161.94 / $2,833.06 / $3,596.19
| Professional | | $2,161.94 | $2,833.06 | $3,596.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.26 / $1,389.62 / $1,887.48
| Professional | | $133.26 | $1,389.62 | $1,887.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,500.37 / $3,465.71 / $4,626.93
| Professional | | $2,500.37 | $3,465.71 | $4,626.93 |
- 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
- $1,688.78 / $2,227.15 / $4,081.68
| Professional | | $1,688.78 | $2,227.15 | $4,081.68 |