- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $1,445.44 / $1,862.09
| Facility | | $575.44 | $1,445.44 | $1,862.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $1,479.11 / $2,884.03
| Professional | | $151.36 | $1,479.11 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $165.96 / $1,380.38
| Professional | | $162.18 | $165.96 | $1,380.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15,135.61 / $17,782.79 / $23,988.33
| Facility | | $15,135.61 | $17,782.79 | $23,988.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $1,318.26 / $2,041.74
| Professional | | $114.82 | $1,318.26 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $263.03 / $3,311.31
| Professional | | $151.36 | $263.03 | $3,311.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,584.89 / $5,248.07 / $8,317.64
| Facility | | $1,584.89 | $5,248.07 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $1,047.13 / $2,290.87
| Professional | | $128.82 | $1,047.13 | $2,290.87 |