- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $3,388.44 / $6,025.60
| Facility | | $1,621.81 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.29 / $1,174.90 / $2,344.23
| Professional | | $1,023.29 | $1,174.90 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,548.82 / $1,995.26
| Professional | | $1,412.54 | $1,548.82 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $5,011.87
| Professional | | $32.36 | $60.26 | $5,011.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,290.87 / $4,786.30
| Professional | | $1,380.38 | $2,290.87 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $2,454.71 / $3,311.31
| Professional | | $977.24 | $2,454.71 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,698.24 / $4,365.16
| Professional | | $1,445.44 | $1,698.24 | $4,365.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $5,128.61 / $13,803.84
| Facility | | $2,290.87 | $5,128.61 | $13,803.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,348.96 / $2,187.76
| Professional | | $1,047.13 | $1,348.96 | $2,187.76 |