- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $9,772.37 / $40,738.03
| Facility | | $467.74 | $9,772.37 | $40,738.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $741.31 / $1,380.38
| Professional | | $512.86 | $741.31 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $588.84 / $758.58
| Professional | | $512.86 | $588.84 | $758.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,918.31 / $6,918.31 / $6,918.31
| Facility | | $6,918.31 | $6,918.31 | $6,918.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,467.37 / $3,467.37 / $3,467.37
| Facility | | $3,467.37 | $3,467.37 | $3,467.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.19 / $602.56 / $1,230.27
| Professional | | $501.19 | $602.56 | $1,230.27 |