- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,206.81 / $5,884.37 / $10,871.00
| Facility | | $1,206.81 | $5,884.37 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,028.33 / $1,276.41 / $2,117.94
| Professional | | $1,028.33 | $1,276.41 | $2,117.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,228.93 / $2,031.34 / $6,176.23
| Professional | | $1,228.93 | $2,031.34 | $6,176.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,579.52 / $1,978.34 / $2,412.80
| Professional | | $1,579.52 | $1,978.34 | $2,412.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,006.45 / $1,273.18 / $2,561.84
| Professional | | $1,006.45 | $1,273.18 | $2,561.84 |
- 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
- $1,067.69 / $1,506.44 / $4,430.56
| Professional | | $1,067.69 | $1,506.44 | $4,430.56 |