- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,016.48 / $1,165.56 / $1,206.22
| Facility | | $1,016.48 | $1,165.56 | $1,206.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,014.93 / $1,165.56 / $1,222.64
| Professional | | $1,014.93 | $1,165.56 | $1,222.64 |
- 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
- $933.72 / $1,014.91 / $1,048.98
| Professional | | $933.72 | $1,014.91 | $1,048.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.22 / $989.22 / $1,302.06
| Facility | | $989.22 | $989.22 | $1,302.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.53 / $989.22 / $1,807.50
| Professional | | $122.53 | $989.22 | $1,807.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $522.87 / $702.62 / $1,199.83
| Professional | | $522.87 | $702.62 | $1,199.83 |