- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.03 / $5,495.41 / $7,762.47
| Facility | | $537.03 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $562.34 / $1,778.28
| Professional | | $478.63 | $562.34 | $1,778.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $645.65 / $2,041.74
| Professional | | $537.03 | $645.65 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $933.25 / $1,445.44
| Professional | | $524.81 | $933.25 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,071.52 / $1,174.90
| Professional | | $512.86 | $1,071.52 | $1,174.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,897.79 / $13,489.63 / $41,686.94
| Facility | | $4,897.79 | $13,489.63 | $41,686.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $707.95 / $1,445.44
| Professional | | $501.19 | $707.95 | $1,445.44 |