- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,905.46 / $3,388.44 / $6,025.60
| Facility | | $1,905.46 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,584.89 / $3,235.94
| Professional | | $1,318.26 | $1,584.89 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $1,862.09 / $3,090.30
| Professional | | $575.44 | $1,862.09 | $3,090.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $3,162.28
| Professional | | $32.36 | $33.11 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,905.46 / $2,344.23 / $3,162.28
| Professional | | $1,905.46 | $2,344.23 | $3,162.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,691.53 / $3,715.35
| Professional | | $1,348.96 | $2,691.53 | $3,715.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,698.24 / $2,187.76 / $3,090.30
| Professional | | $1,698.24 | $2,187.76 | $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
- $1,258.93 / $1,621.81 / $2,570.40
| Professional | | $1,258.93 | $1,621.81 | $2,570.40 |