- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,577.06 / $5,982.00 / $10,871.00
| Facility | | $3,577.06 | $5,982.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,473.92 / $4,197.83 / $6,864.86
| Professional | | $3,473.92 | $4,197.83 | $6,864.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,878.01 / $5,284.30 / $10,524.19
| Professional | | $2,878.01 | $5,284.30 | $10,524.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,530.72 / $6,497.17 / $7,873.18
| Professional | | $4,530.72 | $6,497.17 | $7,873.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,448.03 / $4,772.35 / $7,758.23
| Professional | | $3,448.03 | $4,772.35 | $7,758.23 |
- 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
- $2,638.44 / $4,372.04 / $9,137.10
| Professional | | $2,638.44 | $4,372.04 | $9,137.10 |