- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,038.00 / $3,043.48 / $4,387.00
| Facility | | $3,038.00 | $3,043.48 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,115.42 / $3,043.48 / $6,613.19
| Professional | | $2,115.42 | $3,043.48 | $6,613.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,935.37 / $3,192.22 / $4,413.43
| Professional | | $1,935.37 | $3,192.22 | $4,413.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $188.17 / $1,651.98 / $2,201.82
| Professional | | $188.17 | $1,651.98 | $2,201.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,006.02 / $3,835.96 / $4,879.85
| Professional | | $3,006.02 | $3,835.96 | $4,879.85 |
- 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
- $2,025.89 / $2,660.81 / $4,456.97
| Professional | | $2,025.89 | $2,660.81 | $4,456.97 |