- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,375.35 / $3,038.00 / $4,387.00
| Facility | | $2,375.35 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,634.06 / $2,375.35 / $5,224.46
| Professional | | $1,634.06 | $2,375.35 | $5,224.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,800.72 / $2,455.83 / $3,722.63
| Professional | | $1,800.72 | $2,455.83 | $3,722.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.47 / $1,291.03 / $1,699.62
| Professional | | $137.47 | $1,291.03 | $1,699.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,307.17 / $3,026.74 / $3,956.51
| Professional | | $2,307.17 | $3,026.74 | $3,956.51 |
- 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
- $1,604.75 / $2,184.42 / $3,420.11
| Professional | | $1,604.75 | $2,184.42 | $3,420.11 |