- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $4,073.80 / $7,762.47
| Facility | | $676.08 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $691.83 / $1,995.26
| Professional | | $645.65 | $691.83 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $645.65 / $4,365.16 / $9,120.11
| Professional | | $645.65 | $4,365.16 | $9,120.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.69 / $831.76 / $1,819.70
| Professional | | $660.69 | $831.76 | $1,819.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $630.96 / $1,445.44
| Professional | | $602.56 | $630.96 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $16,218.10 / $26,915.35
| Facility | | $2,344.23 | $16,218.10 | $26,915.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $794.33 / $1,584.89
| Professional | | $562.34 | $794.33 | $1,584.89 |