- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,036.08 / $2,059.55 / $4,662.39
| Facility | | $1,036.08 | $2,059.55 | $4,662.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $935.01 / $1,036.08 / $1,074.00
| Professional | | $935.01 | $1,036.08 | $1,074.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.49 / $3,790.59 / $6,859.70
| Facility | | $7.49 | $3,790.59 | $6,859.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.49 / $7.49 / $10.11
| Professional | | $7.49 | $7.49 | $10.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,263.53 / $1,642.59 / $2,021.65
| Facility | | $1,263.53 | $1,642.59 | $2,021.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,263.53 / $1,516.24 / $1,895.30
| Professional | | $1,263.53 | $1,516.24 | $1,895.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.29 / $2,387.92 / $4,927.91
| Facility | | $821.29 | $2,387.92 | $4,927.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $9.86 / $1,451.70 / $1,843.65
| Professional | | $9.86 | $1,451.70 | $1,843.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.67 / $758.12 / $1,388.62
| Professional | | $530.67 | $758.12 | $1,388.62 |