- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,358.52 / $4,545.34 / $10,871.00
| Facility | | $2,358.52 | $4,545.34 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,334.84 / $2,683.75 / $4,457.37
| Professional | | $2,334.84 | $2,683.75 | $4,457.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,134.52 / $3,483.86 / $6,790.85
| Professional | | $2,134.52 | $3,483.86 | $6,790.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,898.06 / $4,155.71 / $5,035.91
| Professional | | $2,898.06 | $4,155.71 | $5,035.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,145.03 / $3,093.75 / $5,024.47
| Professional | | $2,145.03 | $3,093.75 | $5,024.47 |
- 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
- $1,769.86 / $2,837.36 / $5,862.33
| Professional | | $1,769.86 | $2,837.36 | $5,862.33 |