- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $850.12 / $2,184.80 / $31,663.86
| Facility | | $850.12 | $2,184.80 | $31,663.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.63 / $850.12 / $900.09
| Professional | | $813.63 | $850.12 | $900.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.64 / $1,178.15 / $1,395.94
| Professional | | $841.64 | $1,178.15 | $1,395.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,731.43 / $16,731.43 / $16,731.43
| Facility | | $16,731.43 | $16,731.43 | $16,731.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $832.89 / $1,081.93 / $2,127.46
| Professional | | $832.89 | $1,081.93 | $2,127.46 |