- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $2,818.38 / $8,511.38
| Facility | | $467.74 | $2,818.38 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $478.63 / $2,398.83 / $3,467.37
| Professional | | $478.63 | $2,398.83 | $3,467.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $257.04 / $2,630.27 / $9,772.37
| Facility | | $257.04 | $2,630.27 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $575.44 / $3,630.78
| Professional | | $223.87 | $575.44 | $3,630.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $691.83 / $6,606.93
| Facility | | $208.93 | $691.83 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $354.81 / $741.31
| Professional | | $208.93 | $354.81 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $2,951.21 / $8,912.51
| Facility | | $234.42 | $2,951.21 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.15 / $1,479.11 / $3,311.31
| Professional | | $269.15 | $1,479.11 | $3,311.31 |