- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,398.83 / $3,388.44 / $6,025.60
| Facility | | $2,398.83 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,778.28 / $4,677.35
| Professional | | $1,513.56 | $1,778.28 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,290.87 / $2,884.03
| Professional | | $2,089.30 | $2,290.87 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $9,549.93
| Professional | | $32.36 | $60.26 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,388.44 / $9,332.54
| Professional | | $2,041.74 | $3,388.44 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $3,630.78 / $4,897.79
| Professional | | $1,445.44 | $3,630.78 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,137.96 / $2,511.89 / $8,317.64
| Professional | | $2,137.96 | $2,511.89 | $8,317.64 |
- 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
- $1,548.82 / $1,995.26 / $3,311.31
| Professional | | $1,548.82 | $1,995.26 | $3,311.31 |