- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.58 / $1,107.31 / $2,083.72
| Facility | | $877.58 | $1,107.31 | $2,083.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.02 / $933.53 / $1,112.45
| Professional | | $784.02 | $933.53 | $1,112.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $0.03 / $981.58
| Facility | | $0.02 | $0.03 | $981.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,090.64 / $1,112.45 / $1,243.33
| Professional | | $1,090.64 | $1,112.45 | $1,243.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,001.02 / $1,001.02 / $1,001.02
| Facility | | $1,001.02 | $1,001.02 | $1,001.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,139.40 / $1,407.56 / $2,134.26
| Professional | | $1,139.40 | $1,407.56 | $2,134.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,308.77 / $1,308.77 / $1,348.03
| Professional | | $1,308.77 | $1,308.77 | $1,348.03 |