- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.81 / $816.78 / $1,207.41
| Facility | | $793.81 | $816.78 | $1,207.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.48 / $956.73 / $1,207.41
| Professional | | $787.48 | $956.73 | $1,207.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,060.26 / $1,060.26 / $1,220.20
| Professional | | $1,060.26 | $1,060.26 | $1,220.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.25 / $277.56 / $2,775.60
| Facility | | $161.25 | $277.56 | $2,775.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.17 / $403.13 / $3,507.25
| Professional | | $179.17 | $403.13 | $3,507.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.47 / $1,122.47 / $2,060.42
| Facility | | $1,122.47 | $1,122.47 | $2,060.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.60 / $1,092.34 / $8,635.85
| Professional | | $193.60 | $1,092.34 | $8,635.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.18 / $146.91 / $1,687.77
| Professional | | $110.18 | $146.91 | $1,687.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.64 / $808.18 / $1,176.02
| Professional | | $514.64 | $808.18 | $1,176.02 |