- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $3,388.44 / $6,025.60
| Facility | | $1,412.54 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,174.90 / $2,818.38
| Professional | | $977.24 | $1,174.90 | $2,818.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,380.38 / $2,290.87
| Professional | | $676.08 | $1,380.38 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,344.23
| Professional | | $32.36 | $33.11 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,778.28 / $2,344.23
| Professional | | $1,412.54 | $1,778.28 | $2,344.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,995.26 / $2,754.23
| Professional | | $1,000.00 | $1,995.26 | $2,754.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,621.81 / $2,344.23
| Professional | | $1,258.93 | $1,621.81 | $2,344.23 |
- 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
- $933.25 / $1,202.26 / $1,905.46
| Professional | | $933.25 | $1,202.26 | $1,905.46 |