- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,117.25 / $2,427.78 / $2,512.46
| Facility | | $2,117.25 | $2,427.78 | $2,512.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,090.91 / $2,427.78 / $2,512.46
| Professional | | $2,090.91 | $2,427.78 | $2,512.46 |
- 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 / $2,908.20
| Professional | | $2,247.73 | $2,443.17 | $2,908.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.19 / $2,095.19 / $2,095.19
| Facility | | $2,095.19 | $2,095.19 | $2,095.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.51 / $1,472.88 / $3,637.50
| Professional | | $192.51 | $1,472.88 | $3,637.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.92 / $282.30 / $2,023.95
| Professional | | $112.92 | $282.30 | $2,023.95 |