- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $776.25 / $4,073.80 / $7,762.47
| Facility | | $776.25 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $758.58 / $2,041.74
| Professional | | $676.08 | $758.58 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $2,398.83 / $10,715.19
| Professional | | $741.31 | $2,398.83 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $741.31 / $1,047.13 / $2,041.74
| Professional | | $741.31 | $1,047.13 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $1,513.56 / $1,698.24
| Professional | | $724.44 | $1,513.56 | $1,698.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $16,218.10 / $35,481.34
| Facility | | $3,311.31 | $16,218.10 | $35,481.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $977.24 / $2,089.30
| Professional | | $588.84 | $977.24 | $2,089.30 |