- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,630.78 / $4,786.30
| Facility | | $2,754.23 | $3,630.78 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,754.23 / $3,715.35 / $4,786.30
| Professional | | $2,754.23 | $3,715.35 | $4,786.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.87 / $524.81 / $2,398.83
| Facility | | $416.87 | $524.81 | $2,398.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,884.03 / $4,365.16 / $6,606.93
| Professional | | $2,884.03 | $4,365.16 | $6,606.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.53 / $5,754.40 / $22,908.68
| Facility | | $199.53 | $5,754.40 | $22,908.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $6,456.54 / $8,317.64
| Professional | | $457.09 | $6,456.54 | $8,317.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $2,290.87 / $3,890.45
| Facility | | $309.03 | $2,290.87 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,884.03 / $5,370.32
| Professional | | $2,137.96 | $2,884.03 | $5,370.32 |