- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $3,388.44 / $6,025.60
| Facility | | $2,344.23 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,513.56 / $1,737.80 / $3,388.44
| Professional | | $1,513.56 | $1,737.80 | $3,388.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,041.74 / $2,187.76 / $2,511.89
| Professional | | $2,041.74 | $2,187.76 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $4,677.35
| Professional | | $32.36 | $33.11 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,995.26 / $3,311.31 / $3,548.13
| Professional | | $1,995.26 | $3,311.31 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,548.13 / $4,897.79
| Professional | | $1,412.54 | $3,548.13 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,089.30 / $2,454.71 / $2,884.03
| Professional | | $2,089.30 | $2,454.71 | $2,884.03 |
- 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 / $3,235.94
| Professional | | $1,548.82 | $1,995.26 | $3,235.94 |