- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.55 / $7,838.38 / $7,838.38
| Facility | | $995.55 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $916.83 / $1,012.83 / $1,551.01
| Professional | | $916.83 | $1,012.83 | $1,551.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $272.18 / $1,469.85
| Professional | | $32.34 | $272.18 | $1,469.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $929.71 / $1,183.27 / $1,459.15
| Facility | | $929.71 | $1,183.27 | $1,459.15 |
- 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
- $1,221.30 / $1,546.98 / $2,155.92
| Professional | | $1,221.30 | $1,546.98 | $2,155.92 |