- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,176.86 / $7,838.38 / $14,860.56
| Facility | | $1,176.86 | $7,838.38 | $14,860.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $996.86 / $1,041.27 / $1,948.23
| Professional | | $996.86 | $1,041.27 | $1,948.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,123.76 / $1,581.44 / $1,994.30
| Professional | | $1,123.76 | $1,581.44 | $1,994.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $1,666.61
| Professional | | $32.34 | $32.34 | $1,666.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,212.44 / $1,577.15 / $1,994.30
| Professional | | $1,212.44 | $1,577.15 | $1,994.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,085.00 / $4,262.00 / $17,636.00
| Facility | | $3,085.00 | $4,262.00 | $17,636.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,387.32 / $1,734.15 / $2,490.88
| Professional | | $1,387.32 | $1,734.15 | $2,490.88 |