- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.77 / $986.78 / $1,594.30
| Professional | | $986.77 | $986.78 | $1,594.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,598.55 / $7,260.72 / $8,187.38
| Facility | | $5,598.55 | $7,260.72 | $8,187.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,031.36 / $1,183.66 / $1,754.97
| Professional | | $1,031.36 | $1,183.66 | $1,754.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $929.70 / $1,224.80 / $1,831.25
| Professional | | $929.70 | $1,224.80 | $1,831.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.66 / $1,277.18 / $1,959.26
| Professional | | $991.66 | $1,277.18 | $1,959.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.77 / $986.78 / $1,594.30
| Professional | | $986.77 | $986.78 | $1,594.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $850.46 / $1,167.14 / $1,703.32
| Professional | | $850.46 | $1,167.14 | $1,703.32 |