- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,041.74 / $3,388.44 / $6,025.60
| Facility | | $2,041.74 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,621.81 / $3,467.37
| Professional | | $1,412.54 | $1,621.81 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $2,041.74 / $3,235.94
| Professional | | $676.08 | $2,041.74 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $60.26
| Professional | | $32.36 | $33.11 | $60.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $2,570.40 / $3,311.31
| Professional | | $1,949.84 | $2,570.40 | $3,311.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,380.38 / $3,162.28 / $4,365.16
| Professional | | $1,380.38 | $3,162.28 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $2,238.72 / $3,090.30
| Professional | | $1,737.80 | $2,238.72 | $3,090.30 |
- 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
- $1,380.38 / $1,698.24 / $2,691.53
| Professional | | $1,380.38 | $1,698.24 | $2,691.53 |