- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,015.82 / $4,294.00 / $10,871.00
| Facility | | $2,015.82 | $4,294.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,986.35 / $2,201.16 / $3,806.03
| Professional | | $1,986.35 | $2,201.16 | $3,806.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,502.82 / $2,871.40 / $5,996.55
| Professional | | $1,502.82 | $2,871.40 | $5,996.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,242.04 / $3,269.36 / $4,007.31
| Professional | | $2,242.04 | $3,269.36 | $4,007.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,758.06 / $2,559.89 / $4,790.83
| Professional | | $1,758.06 | $2,559.89 | $4,790.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,627.00 / $6,590.00 / $10,536.00
| Facility | | $1,627.00 | $6,590.00 | $10,536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.13 / $2,229.73 / $4,876.00
| Professional | | $1,443.13 | $2,229.73 | $4,876.00 |