- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $807.30 / $4,230.25 / $5,546.15
| Facility | | $807.30 | $4,230.25 | $5,546.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.02 / $708.63 / $1,049.49
| Professional | | $592.02 | $708.63 | $1,049.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $766.71 / $788.56 / $2,471.55
| Facility | | $766.71 | $788.56 | $2,471.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.84 / $1,030.84 / $1,288.56
| Professional | | $1,030.84 | $1,030.84 | $1,288.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $923.91 / $1,031.55 / $1,076.40
| Facility | | $923.91 | $1,031.55 | $1,076.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $686.61 / $701.89 / $762.90
| Professional | | $686.61 | $701.89 | $762.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.74 / $376.74 / $538.20
| Professional | | $376.74 | $376.74 | $538.20 |