- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,388.44 / $6,025.60
| Facility | | $2,691.53 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,089.30 / $2,818.38
| Professional | | $1,737.80 | $2,089.30 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,344.23 / $2,570.40 / $3,311.31
| Professional | | $2,344.23 | $2,570.40 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $12,302.69
| Professional | | $32.36 | $60.26 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,290.87 / $3,548.13 / $12,022.64
| Professional | | $2,290.87 | $3,548.13 | $12,022.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $4,073.80 / $5,623.41
| Professional | | $1,621.81 | $4,073.80 | $5,623.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,398.83 / $2,818.38 / $10,715.19
| Professional | | $2,398.83 | $2,818.38 | $10,715.19 |
- 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
- $1,778.28 / $2,290.87 / $3,715.35
| Professional | | $1,778.28 | $2,290.87 | $3,715.35 |