- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,666.48 / $6,325.00 / $11,298.00
| Facility | | $1,666.48 | $6,325.00 | $11,298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,216.18 / $1,591.64 / $1,865.58
| Professional | | $1,216.18 | $1,591.64 | $1,865.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,154.50 / $1,648.73 / $2,543.08
| Professional | | $1,154.50 | $1,648.73 | $2,543.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,846.00 / $7,273.00 / $10,536.00
| Facility | | $1,846.00 | $7,273.00 | $10,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,323.55 / $2,011.94 / $3,700.09
| Professional | | $1,323.55 | $2,011.94 | $3,700.09 |