- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.30 / $247.83 / $1,787.26
| Facility | | $241.30 | $247.83 | $1,787.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.71 / $1,075.58 / $2,776.34
| Professional | | $201.71 | $1,075.58 | $2,776.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.12 / $213.87 / $236.74
| Professional | | $207.12 | $213.87 | $236.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.82 / $519.07 / $3,879.56
| Professional | | $197.82 | $519.07 | $3,879.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.49 / $1,801.68 / $3,401.16
| Professional | | $1,047.49 | $1,801.68 | $3,401.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,951.88 / $2,828.11 / $4,462.18
| Professional | | $1,951.88 | $2,828.11 | $4,462.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,396.65 / $1,396.65 / $1,975.95
| Professional | | $1,396.65 | $1,396.65 | $1,975.95 |