- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $6,025.60 / $10,964.78
| Facility | | $1,819.70 | $6,025.60 | $10,964.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,380.38 / $2,754.23
| Professional | | $1,230.27 | $1,380.38 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,584.89 / $1,819.70 / $3,548.13
| Professional | | $1,584.89 | $1,819.70 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $60.26 / $3,715.35
| Professional | | $32.36 | $60.26 | $3,715.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,786.30 / $5,623.41 / $12,589.25
| Facility | | $4,786.30 | $5,623.41 | $12,589.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,621.81 / $2,818.38 / $3,548.13
| Professional | | $1,621.81 | $2,818.38 | $3,548.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,884.03 / $3,981.07
| Professional | | $1,096.48 | $2,884.03 | $3,981.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $1,995.26 / $3,090.30
| Professional | | $1,698.24 | $1,995.26 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,137.96 / $5,128.61 / $8,317.64
| Facility | | $2,137.96 | $5,128.61 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,584.89 / $2,630.27
| Professional | | $1,230.27 | $1,584.89 | $2,630.27 |