- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,388.44 / $6,025.60
| Facility | | $1,288.25 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,047.13 / $2,754.23
| Professional | | $870.96 | $1,047.13 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,288.25 / $2,041.74
| Professional | | $575.44 | $1,288.25 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,137.96
| Professional | | $32.36 | $33.11 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,621.81 / $2,137.96
| Professional | | $1,258.93 | $1,621.81 | $2,137.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,995.26 / $2,754.23
| Professional | | $870.96 | $1,995.26 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,096.48 / $1,445.44 / $2,137.96
| Professional | | $1,096.48 | $1,445.44 | $2,137.96 |
- 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
- $851.14 / $1,071.52 / $1,698.24
| Professional | | $851.14 | $1,071.52 | $1,698.24 |