- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,412.54 / $5,495.41 / $7,079.46
| Facility | | $1,412.54 | $5,495.41 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $5,370.32 / $8,511.38
| Professional | | $489.78 | $5,370.32 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $8,511.38 / $16,218.10
| Professional | | $489.78 | $8,511.38 | $16,218.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $1,412.54 / $15,135.61
| Professional | | $501.19 | $1,412.54 | $15,135.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,148.15 / $6,760.83 / $14,791.08
| Professional | | $1,148.15 | $6,760.83 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $13,489.63 / $41,686.94
| Facility | | $4,897.79 | $13,489.63 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $1,659.59 / $14,454.40
| Professional | | $478.63 | $1,659.59 | $14,454.40 |