- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $979.03 / $1,811.21 / $3,668.09
| Facility | | $979.03 | $1,811.21 | $3,668.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $979.03 / $1,018.19 / $1,109.56
| Professional | | $979.03 | $1,018.19 | $1,109.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $678.79 / $848.49 / $2,088.59
| Professional | | $678.79 | $848.49 | $2,088.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $861.22 / $2,812.40 / $3,733.36
| Facility | | $861.22 | $2,812.40 | $3,733.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,500.02 / $1,590.88 / $1,988.60
| Professional | | $1,500.02 | $1,590.88 | $1,988.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,271.34 / $6,200.51 / $6,200.51
| Facility | | $2,271.34 | $6,200.51 | $6,200.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $548.26 / $783.22 / $1,305.36
| Professional | | $548.26 | $783.22 | $1,305.36 |