- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,760.40 / $5,982.00 / $11,298.00
| Facility | | $2,760.40 | $5,982.00 | $11,298.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,385.48 / $2,772.17 / $4,942.97
| Professional | | $2,385.48 | $2,772.17 | $4,942.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,521.44 / $4,575.59 / $13,613.28
| Professional | | $2,521.44 | $4,575.59 | $13,613.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,101.60 / $4,215.03 / $4,987.87
| Professional | | $3,101.60 | $4,215.03 | $4,987.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,402.27 / $3,038.93 / $5,842.43
| Professional | | $2,402.27 | $3,038.93 | $5,842.43 |
- 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
- $2,235.89 / $3,113.86 / $8,477.91
| Professional | | $2,235.89 | $3,113.86 | $8,477.91 |