- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,225.46 / $3,038.00 / $4,387.00
| Facility | | $2,225.46 | $3,038.00 | $4,387.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,090.63 / $2,225.46 / $3,063.27
| Professional | | $2,090.63 | $2,225.46 | $3,063.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,157.12 / $2,506.44 / $4,111.88
| Professional | | $2,157.12 | $2,506.44 | $4,111.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.07 / $1,267.10 / $1,724.00
| Professional | | $187.07 | $1,267.10 | $1,724.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,403.33 / $3,141.26 / $3,749.08
| Professional | | $2,403.33 | $3,141.26 | $3,749.08 |
- 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
- $1,728.21 / $2,106.38 / $3,810.96
| Professional | | $1,728.21 | $2,106.38 | $3,810.96 |