- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.42 / $5,695.00 / $10,871.00
| Facility | | $2,234.42 | $5,695.00 | $10,871.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,984.59 / $2,435.59 / $3,687.34
| Professional | | $1,984.59 | $2,435.59 | $3,687.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,302.17 / $3,658.03 / $8,758.12
| Professional | | $2,302.17 | $3,658.03 | $8,758.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,312.82 / $3,182.81 / $4,104.31
| Professional | | $2,312.82 | $3,182.81 | $4,104.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,128.26 / $2,814.80 / $6,089.44
| Professional | | $2,128.26 | $2,814.80 | $6,089.44 |
- 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
- $1,758.27 / $3,282.11 / $8,450.62
| Professional | | $1,758.27 | $3,282.11 | $8,450.62 |