- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,485.78 / $5,982.00 / $10,871.00
| Facility | | $3,485.78 | $5,982.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,280.23 / $3,873.04 / $6,288.26
| Professional | | $3,280.23 | $3,873.04 | $6,288.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,658.32 / $4,951.39 / $9,607.33
| Professional | | $2,658.32 | $4,951.39 | $9,607.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,647.22 / $6,002.04 / $7,269.68
| Professional | | $4,647.22 | $6,002.04 | $7,269.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,179.21 / $4,492.13 / $7,555.46
| Professional | | $3,179.21 | $4,492.13 | $7,555.46 |
- 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
- $2,426.16 / $4,095.82 / $8,823.60
| Professional | | $2,426.16 | $4,095.82 | $8,823.60 |