- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,019.95 / $3,388.44 / $6,025.60
| Facility | | $3,019.95 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,862.09 / $2,344.23 / $4,897.79
| Professional | | $1,862.09 | $2,344.23 | $4,897.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $2,884.03 / $4,677.35
| Professional | | $1,778.28 | $2,884.03 | $4,677.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $6,456.54
| Professional | | $32.36 | $33.11 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,388.44 / $5,370.32 / $10,232.93
| Professional | | $3,388.44 | $5,370.32 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,949.84 / $5,011.87 / $6,606.93
| Professional | | $1,949.84 | $5,011.87 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,235.94 / $3,715.35 / $5,128.61
| Professional | | $3,235.94 | $3,715.35 | $5,128.61 |
- 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
- $1,905.46 / $2,398.83 / $4,365.16
| Professional | | $1,905.46 | $2,398.83 | $4,365.16 |