- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,648.71 / $6,922.00 / $12,831.00
| Facility | | $2,648.71 | $6,922.00 | $12,831.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,264.08 / $2,559.32 / $4,329.35
| Professional | | $2,264.08 | $2,559.32 | $4,329.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,455.30 / $3,761.76 / $8,526.37
| Professional | | $2,455.30 | $3,761.76 | $8,526.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,276.82 / $3,679.58 / $3,941.93
| Professional | | $2,276.82 | $3,679.58 | $3,941.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,230.46 / $3,065.86 / $7,314.10
| Professional | | $2,230.46 | $3,065.86 | $7,314.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,066.00 / $12,315.00 / $27,214.00
| Facility | | $6,066.00 | $12,315.00 | $27,214.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,040.39 / $3,120.23 / $7,664.54
| Professional | | $2,040.39 | $3,120.23 | $7,664.54 |