- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.00 / $3,124.72 / $4,387.00
| Facility | | $3,038.00 | $3,124.72 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,050.32 / $2,986.57 / $6,385.83
| Professional | | $2,050.32 | $2,986.57 | $6,385.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,263.73 / $3,155.13 / $4,663.89
| Professional | | $2,263.73 | $3,155.13 | $4,663.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.17 / $1,603.23 / $2,138.88
| Professional | | $188.17 | $1,603.23 | $2,138.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,896.79 / $3,872.25 / $5,085.12
| Professional | | $2,896.79 | $3,872.25 | $5,085.12 |
- 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
- $1,994.36 / $2,683.19 / $4,303.85
| Professional | | $1,994.36 | $2,683.19 | $4,303.85 |