- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,413.10 / $7,413.10 / $8,128.31
| Facility | | $7,413.10 | $7,413.10 | $8,128.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.17 / $269.15 / $562.34
| Professional | | $204.17 | $269.15 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,348.96 / $1,698.24
| Facility | | $1,348.96 | $1,348.96 | $1,698.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $309.03 / $912.01
| Professional | | $213.80 | $309.03 | $912.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $295.12 / $537.03
| Professional | | $218.78 | $295.12 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $288.40 / $562.34
| Professional | | $218.78 | $288.40 | $562.34 |