- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $3,388.44 / $6,025.60
| Facility | | $1,819.70 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,202.26 / $1,380.38 / $2,884.03
| Professional | | $1,202.26 | $1,380.38 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,737.80 / $2,884.03
| Professional | | $1,071.52 | $1,737.80 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $2,511.89
| Professional | | $32.36 | $33.11 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,818.38 / $5,888.44
| Professional | | $1,659.59 | $2,818.38 | $5,888.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $2,344.23 / $2,691.53
| Professional | | $1,122.02 | $2,344.23 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,659.59 / $2,041.74 / $3,090.30
| Professional | | $1,659.59 | $2,041.74 | $3,090.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.48 / $2,818.38 / $5,128.61
| Facility | | $1,096.48 | $2,818.38 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,479.11 / $2,630.27
| Professional | | $1,230.27 | $1,479.11 | $2,630.27 |