- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,754.23 / $4,073.80
| Facility | | $467.74 | $2,754.23 | $4,073.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $426.58 / $1,023.29
| Professional | | $363.08 | $426.58 | $1,023.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $1,071.52 / $2,454.71
| Professional | | $407.38 | $1,071.52 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.38 / $549.54 / $1,148.15
| Professional | | $407.38 | $549.54 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $891.25 / $1,047.13
| Professional | | $524.81 | $891.25 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $549.54 / $7,943.28
| Facility | | $213.80 | $549.54 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.23 / $537.03 / $1,148.15
| Professional | | $316.23 | $537.03 | $1,148.15 |