- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,288.25 / $3,388.44 / $6,025.60
| Facility | | $1,288.25 | $3,388.44 | $6,025.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $794.33 / $1,148.15 / $4,786.30
| Professional | | $794.33 | $1,148.15 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $776.25 / $1,258.93 / $1,949.84
| Professional | | $776.25 | $1,258.93 | $1,949.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.36 / $33.11 / $691.83
| Professional | | $32.36 | $33.11 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,445.44 / $1,778.28 / $2,691.53
| Professional | | $1,445.44 | $1,778.28 | $2,691.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $851.14 / $1,698.24 / $2,238.72
| Professional | | $851.14 | $1,698.24 | $2,238.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,174.90 / $1,513.56 / $2,041.74
| Professional | | $1,174.90 | $1,513.56 | $2,041.74 |
- 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
- $758.58 / $954.99 / $1,548.82
| Professional | | $758.58 | $954.99 | $1,548.82 |