- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $527.20 / $1,024.10 / $1,109.19
| Facility | | $527.20 | $1,024.10 | $1,109.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.60 / $634.16 / $1,066.53
| Professional | | $580.60 | $634.16 | $1,066.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $472.50 / $661.50 / $1,476.58
| Professional | | $472.50 | $661.50 | $1,476.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.00 / $947.00 / $947.00
| Professional | | $947.00 | $947.00 | $947.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $541.28 / $972.15 / $1,248.85
| Professional | | $541.28 | $972.15 | $1,248.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.09 / $742.32 / $1,522.63
| Professional | | $530.09 | $742.32 | $1,522.63 |