- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,379.18 / $5,982.00 / $11,298.00
| Facility | | $1,379.18 | $5,982.00 | $11,298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,273.60 / $1,400.02 / $2,577.09
| Professional | | $1,273.60 | $1,400.02 | $2,577.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,354.42 / $2,265.16 / $4,404.27
| Professional | | $1,354.42 | $2,265.16 | $4,404.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,777.81 / $2,382.96 / $2,842.18
| Professional | | $1,777.81 | $2,382.96 | $2,842.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,227.53 / $1,603.54 / $3,015.16
| Professional | | $1,227.53 | $1,603.54 | $3,015.16 |
- 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
- $1,403.42 / $1,928.19 / $3,374.33
| Professional | | $1,403.42 | $1,928.19 | $3,374.33 |