- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,156.15 / $5,982.00 / $11,298.00
| Facility | | $2,156.15 | $5,982.00 | $11,298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,961.59 / $2,179.06 / $2,431.07
| Professional | | $1,961.59 | $2,179.06 | $2,431.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,985.57 / $3,075.30 / $6,713.62
| Professional | | $1,985.57 | $3,075.30 | $6,713.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,072.03 / $3,363.65 / $3,743.34
| Professional | | $3,072.03 | $3,363.65 | $3,743.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,649.07 / $2,032.49 / $3,834.59
| Professional | | $1,649.07 | $2,032.49 | $3,834.59 |
- 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
- $1,899.52 / $2,384.25 / $5,409.54
| Professional | | $1,899.52 | $2,384.25 | $5,409.54 |