- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $648.04 / $1,103.70 / $15,772.80
| Facility | | $648.04 | $1,103.70 | $15,772.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $759.70 / $2,653.59 / $16,284.40
| Professional | | $759.70 | $2,653.59 | $16,284.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $435.15 / $435.15 / $819.12
| Professional | | $435.15 | $435.15 | $819.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,796.13 / $10,796.13 / $12,955.36
| Facility | | $10,796.13 | $10,796.13 | $12,955.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $498.13 / $732.55 / $10,259.59
| Professional | | $498.13 | $732.55 | $10,259.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.24 / $500.42 / $941.99
| Professional | | $477.24 | $500.42 | $941.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $8,860.54 / $11,909.51 / $17,906.91
| Professional | | $8,860.54 | $11,909.51 | $17,906.91 |