- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $5,128.61 / $7,762.47
| Facility | | $501.19 | $5,128.61 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $512.86 / $1,479.11
| Professional | | $489.78 | $512.86 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $3,235.94 / $7,079.46
| Professional | | $512.86 | $3,235.94 | $7,079.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $602.56 / $1,380.38
| Professional | | $489.78 | $602.56 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.09 / $478.63 / $1,071.52
| Professional | | $457.09 | $478.63 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $14,454.40 / $26,302.68
| Facility | | $2,344.23 | $14,454.40 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $588.84 / $1,174.90
| Professional | | $416.87 | $588.84 | $1,174.90 |