- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,460.32 / $3,038.00 / $4,387.00
| Facility | | $2,460.32 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,728.63 / $2,460.32 / $5,414.70
| Professional | | $1,728.63 | $2,460.32 | $5,414.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,849.24 / $2,608.92 / $3,878.71
| Professional | | $1,849.24 | $2,608.92 | $3,878.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.67 / $1,359.27 / $1,822.35
| Professional | | $160.67 | $1,359.27 | $1,822.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,457.29 / $3,099.81 / $4,052.02
| Professional | | $2,457.29 | $3,099.81 | $4,052.02 |
- 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
- $1,675.55 / $2,333.17 / $3,813.66
| Professional | | $1,675.55 | $2,333.17 | $3,813.66 |