- 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
- $436.52 / $501.19 / $1,348.96
| Professional | | $436.52 | $501.19 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $2,570.40 / $6,456.54
| Professional | | $512.86 | $2,570.40 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.68 / $575.44 / $1,258.93
| Professional | | $446.68 | $575.44 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.87 / $436.52 / $977.24
| Professional | | $416.87 | $436.52 | $977.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $16,218.10 / $31,622.78
| Facility | | $3,311.31 | $16,218.10 | $31,622.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $537.03 / $1,202.26
| Professional | | $380.19 | $537.03 | $1,202.26 |