- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,196.48 / $1,371.96 / $1,419.82
| Facility | | $1,196.48 | $1,371.96 | $1,419.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,012.80 / $1,371.96 / $1,419.82
| Professional | | $1,012.80 | $1,371.96 | $1,419.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $0.03
| Facility | | $0.02 | $0.03 | $0.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.08 / $1,166.40 / $1,303.79
| Professional | | $1,073.08 | $1,166.40 | $1,303.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.47 / $1,122.47 / $1,496.40
| Facility | | $1,122.47 | $1,122.47 | $1,496.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.82 / $1,122.47 / $2,077.50
| Professional | | $140.82 | $1,122.47 | $2,077.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $588.84 / $792.28 / $1,350.27
| Professional | | $588.84 | $792.28 | $1,350.27 |