- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.36 / $1,762.27 / $1,798.87
| Facility | | $920.36 | $1,762.27 | $1,798.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $737.98 / $911.15 / $1,310.29
| Professional | | $737.98 | $911.15 | $1,310.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $917.19 / $1,248.06 / $10,432.00
| Facility | | $917.19 | $1,248.06 | $10,432.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.77 / $865.82 / $981.36
| Professional | | $364.77 | $865.82 | $981.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.66 / $524.66 / $610.76
| Professional | | $524.66 | $524.66 | $610.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $416.79 / $568.82 / $1,294.13
| Professional | | $416.79 | $568.82 | $1,294.13 |