- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,070.20 / $3,106.75 / $6,615.55
| Facility | | $3,070.20 | $3,106.75 | $6,615.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,942.27 / $3,033.65 / $3,106.75
| Professional | | $2,942.27 | $3,033.65 | $3,106.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.05
| Facility | | $0.02 | $0.03 | $0.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,978.82 / $3,045.83 / $3,106.75
| Professional | | $2,978.82 | $3,045.83 | $3,106.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,746.19 / $3,966.54 / $4,045.87
| Facility | | $3,746.19 | $3,966.54 | $4,045.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,833.05 / $2,994.46 / $3,506.25
| Professional | | $2,833.05 | $2,994.46 | $3,506.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,335.04 / $3,838.44 / $3,838.44
| Facility | | $3,335.04 | $3,838.44 | $3,838.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,045.83 / $3,045.83 / $3,411.33
| Professional | | $3,045.83 | $3,045.83 | $3,411.33 |