- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $4,073.80 / $7,762.47
| Facility | | $478.63 | $4,073.80 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $602.56 / $1,621.81
| Professional | | $478.63 | $602.56 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $5,495.41 / $10,715.19
| Professional | | $588.84 | $5,495.41 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $707.95 / $1,479.11
| Professional | | $524.81 | $707.95 | $1,479.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $549.54 / $1,288.25
| Professional | | $524.81 | $549.54 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,311.31 / $16,218.10 / $27,542.29
| Facility | | $3,311.31 | $16,218.10 | $27,542.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.78 / $676.08 / $1,412.54
| Professional | | $489.78 | $676.08 | $1,412.54 |