- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.72 / $5,982.00 / $11,298.00
| Facility | | $2,000.72 | $5,982.00 | $11,298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,653.69 / $2,031.45 / $3,401.28
| Professional | | $1,653.69 | $2,031.45 | $3,401.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,856.25 / $3,217.77 / $9,940.25
| Professional | | $1,856.25 | $3,217.77 | $9,940.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,510.34 / $3,129.74 / $3,827.13
| Professional | | $2,510.34 | $3,129.74 | $3,827.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,761.44 / $2,229.98 / $4,709.29
| Professional | | $1,761.44 | $2,229.98 | $4,709.29 |
- 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
- $1,841.39 / $2,710.08 / $6,359.08
| Professional | | $1,841.39 | $2,710.08 | $6,359.08 |