- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.96 / $3,162.28 / $7,762.47
| Facility | | $630.96 | $3,162.28 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $645.65 / $1,905.46
| Professional | | $616.60 | $645.65 | $1,905.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,258.93 / $7,943.28
| Professional | | $630.96 | $1,258.93 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $794.33 / $1,698.24
| Professional | | $616.60 | $794.33 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $575.44 / $1,318.26
| Professional | | $549.54 | $575.44 | $1,318.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,023.29 / $8,128.31 / $26,915.35
| Facility | | $1,023.29 | $8,128.31 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $741.31 / $1,479.11
| Professional | | $537.03 | $741.31 | $1,479.11 |