- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,750.91 / $6,396.00 / $11,298.00
| Facility | | $2,750.91 | $6,396.00 | $11,298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,279.61 / $2,722.01 / $4,484.20
| Professional | | $2,279.61 | $2,722.01 | $4,484.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,613.98 / $3,845.35 / $7,980.38
| Professional | | $2,613.98 | $3,845.35 | $7,980.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,425.46 / $4,095.19 / $4,201.38
| Professional | | $2,425.46 | $4,095.19 | $4,201.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,167.36 / $3,052.41 / $6,628.05
| Professional | | $2,167.36 | $3,052.41 | $6,628.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,682.00 / $10,536.00 / $23,291.00
| Facility | | $5,682.00 | $10,536.00 | $23,291.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,176.29 / $3,039.02 / $7,596.36
| Professional | | $2,176.29 | $3,039.02 | $7,596.36 |