- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $622.41 / $948.81 / $1,138.57
| Facility | | $622.41 | $948.81 | $1,138.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $569.29 / $622.41 / $645.19
| Professional | | $569.29 | $622.41 | $645.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.72 / $2,732.58 / $20,494.36
| Facility | | $675.72 | $2,732.58 | $20,494.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.41 / $1,024.72 / $119,998.80
| Professional | | $654.41 | $1,024.72 | $119,998.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.73 / $910.86 / $2,276.94
| Facility | | $616.73 | $910.86 | $2,276.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3,658.62 / $3,658.62 / $3,658.62
| Professional | | $3,658.62 | $3,658.62 | $3,658.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.80 / $379.53 / $1,024.72
| Professional | | $318.80 | $379.53 | $1,024.72 |