- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,630.27 / $3,388.44 / $6,025.60
| Facility | | $2,630.27 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,137.96 / $4,365.16
| Professional | | $1,778.28 | $2,137.96 | $4,365.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $2,570.40 / $4,168.69
| Professional | | $676.08 | $2,570.40 | $4,168.69 |
- 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
- $2,570.40 / $3,311.31 / $4,168.69
| Professional | | $2,570.40 | $3,311.31 | $4,168.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $3,630.78 / $5,128.61
| Professional | | $1,778.28 | $3,630.78 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,454.71 / $2,884.03 / $3,981.07
| Professional | | $2,454.71 | $2,884.03 | $3,981.07 |
- 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
- $1,737.80 / $2,187.76 / $3,467.37
| Professional | | $1,737.80 | $2,187.76 | $3,467.37 |