- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.31 / $2,162.55 / $16,485.47
| Facility | | $818.31 | $2,162.55 | $16,485.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $733.85 / $1,827.33 / $4,829.70
| Professional | | $733.85 | $1,827.33 | $4,829.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $764.43 / $765.15 / $1,092.98
| Professional | | $764.43 | $765.15 | $1,092.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,659.03 / $2,659.03 / $2,659.03
| Facility | | $2,659.03 | $2,659.03 | $2,659.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $717.21 / $1,544.23 / $3,906.35
| Professional | | $717.21 | $1,544.23 | $3,906.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,374.40 / $2,085.85 / $3,774.97
| Professional | | $1,374.40 | $2,085.85 | $3,774.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,608.18 / $2,361.44 / $4,088.31
| Professional | | $1,608.18 | $2,361.44 | $4,088.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,616.94 / $1,859.48 / $2,297.19
| Professional | | $1,616.94 | $1,859.48 | $2,297.19 |