- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $4,073.80 / $7,762.47
| Facility | | $549.54 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $524.81 / $1,202.26
| Professional | | $426.58 | $524.81 | $1,202.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $1,659.59 / $5,128.61
| Professional | | $512.86 | $1,659.59 | $5,128.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $630.96 / $1,479.11
| Professional | | $512.86 | $630.96 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $977.24 / $1,202.26
| Professional | | $537.03 | $977.24 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $8,128.31 / $26,302.68
| Facility | | $1,023.29 | $8,128.31 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.81 / $645.65 / $1,412.54
| Professional | | $354.81 | $645.65 | $1,412.54 |