- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,942.28 / $2,227.14 / $2,304.83
| Facility | | $1,942.28 | $2,227.14 | $2,304.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,911.80 / $2,227.14 / $2,304.83
| Professional | | $1,911.80 | $2,227.14 | $2,304.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.03
| Facility | | $0.02 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,247.73 / $2,443.17 / $2,443.17
| Professional | | $2,247.73 | $2,443.17 | $2,443.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.33 / $303.33 / $2,063.21
| Facility | | $303.33 | $303.33 | $2,063.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.51 / $257.83 / $3,609.38
| Professional | | $192.51 | $257.83 | $3,609.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.59 / $251.21 / $2,040.12
| Professional | | $103.59 | $251.21 | $2,040.12 |