- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $3,162.28 / $7,762.47
| Facility | | $478.63 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $457.09 / $1,096.48
| Professional | | $380.19 | $457.09 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,071.52 / $2,454.71
| Professional | | $467.74 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.52 / $524.81 / $1,288.25
| Professional | | $436.52 | $524.81 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $851.14 / $1,071.52
| Professional | | $478.63 | $851.14 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $1,548.82
| Facility | | $213.80 | $549.54 | $1,548.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $549.54 / $1,202.26
| Professional | | $316.23 | $549.54 | $1,202.26 |