- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,639.02 / $1,803.62 / $2,254.52
| Professional | | $1,639.02 | $1,803.62 | $2,254.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $1,445.03 / $1,445.03
| Professional | | $150.00 | $1,445.03 | $1,445.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,451.00 / $2,800.00 / $22,807.05
| Facility | | $1,451.00 | $2,800.00 | $22,807.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,299.67 / $4,349.77 / $4,349.77
| Professional | | $1,299.67 | $4,349.77 | $4,349.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $971.83 / $1,451.00 / $1,621.81
| Facility | | $971.83 | $1,451.00 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $971.83 / $1,451.00 / $1,902.89
| Professional | | $971.83 | $1,451.00 | $1,902.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $1,384.90 / $2,131.40
| Professional | | $7.00 | $1,384.90 | $2,131.40 |