- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,262.00 / $2,593.76 / $2,684.24
| Facility | | $2,262.00 | $2,593.76 | $2,684.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,226.61 / $2,593.76 / $2,684.24
| Professional | | $2,226.61 | $2,593.76 | $2,684.24 |
- 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 / $3,331.44
| Professional | | $2,247.73 | $2,443.17 | $3,331.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,095.19 / $3,685.49 / $3,685.49
| Facility | | $2,095.19 | $3,685.49 | $3,685.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.51 / $3,132.67 / $3,685.49
| Professional | | $192.51 | $3,132.67 | $3,685.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.64 / $337.12 / $2,175.92
| Professional | | $120.64 | $337.12 | $2,175.92 |