- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $3,388.44 / $6,025.60
| Facility | | $1,348.96 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $1,047.13 / $1,905.46
| Professional | | $954.99 | $1,047.13 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $1,445.44 / $2,238.72
| Professional | | $891.25 | $1,445.44 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $1,949.84
| Professional | | $32.36 | $33.11 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,412.54 / $1,862.09 / $2,290.87
| Professional | | $1,412.54 | $1,862.09 | $2,290.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.24 / $1,698.24 / $2,187.76
| Professional | | $977.24 | $1,698.24 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,659.59 / $2,398.83
| Professional | | $1,348.96 | $1,659.59 | $2,398.83 |
- 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
- $977.24 / $1,202.26 / $2,187.76
| Professional | | $977.24 | $1,202.26 | $2,187.76 |