- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $5,495.41 / $7,762.47
| Facility | | $467.74 | $5,495.41 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $588.84 / $1,737.80
| Professional | | $467.74 | $588.84 | $1,737.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $616.60 / $3,715.35 / $7,943.28
| Professional | | $616.60 | $3,715.35 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $758.58 / $1,445.44
| Professional | | $524.81 | $758.58 | $1,445.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $537.03 / $1,258.93
| Professional | | $512.86 | $537.03 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $16,218.10 / $26,302.68
| Facility | | $2,344.23 | $16,218.10 | $26,302.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $691.83 / $1,380.38
| Professional | | $478.63 | $691.83 | $1,380.38 |