- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $831.76 / $2,137.96 / $7,762.47
| Facility | | $831.76 | $2,137.96 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $1,584.89 / $2,089.30
| Professional | | $537.03 | $1,584.89 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7,079.46 / $9,332.54 / $20,417.38
| Professional | | $7,079.46 | $9,332.54 | $20,417.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $630.96 / $1,288.25
| Professional | | $602.56 | $630.96 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $13,489.63 / $26,302.68
| Facility | | $2,344.23 | $13,489.63 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,318.26 / $1,949.84 / $4,265.80
| Professional | | $1,318.26 | $1,949.84 | $4,265.80 |