- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,306.06 / $5,695.00 / $10,871.00
| Facility | | $2,306.06 | $5,695.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,042.02 / $2,531.23 / $3,853.11
| Professional | | $2,042.02 | $2,531.23 | $3,853.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,440.80 / $3,800.47 / $9,103.54
| Professional | | $2,440.80 | $3,800.47 | $9,103.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,401.98 / $3,306.39 / $4,263.66
| Professional | | $2,401.98 | $3,306.39 | $4,263.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,212.08 / $2,966.23 / $6,814.20
| Professional | | $2,212.08 | $2,966.23 | $6,814.20 |
- 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
- $1,781.49 / $3,376.93 / $6,758.73
| Professional | | $1,781.49 | $3,376.93 | $6,758.73 |