- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.43 / $741.32 / $3,447.44
| Facility | | $319.43 | $741.32 | $3,447.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.43 / $452.03 / $512.29
| Professional | | $319.43 | $452.03 | $512.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $589.14 / $890.52 / $1,898.28
| Facility | | $589.14 | $890.52 | $1,898.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.89 / $789.54 / $1,098.11
| Professional | | $421.89 | $789.54 | $1,098.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.38 / $602.70 / $8,702.00
| Facility | | $192.38 | $602.70 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.13 / $361.62 / $617.77
| Professional | | $253.13 | $361.62 | $617.77 |