- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $596.41 / $596.41 / $1,531.31
| Facility | | $596.41 | $596.41 | $1,531.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $596.41 / $828.39 / $1,531.31
| Professional | | $596.41 | $828.39 | $1,531.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,840.86 / $1,840.86 / $1,840.86
| Facility | | $1,840.86 | $1,840.86 | $1,840.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,011.93 / $1,029.32 / $2,246.46
| Professional | | $1,011.93 | $1,029.32 | $2,246.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.56 / $1,329.56 / $1,355.18
| Facility | | $1,329.56 | $1,329.56 | $1,355.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $970.58 / $970.58 / $2,186.63
| Professional | | $970.58 | $970.58 | $2,186.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,023.67 / $1,530.63 / $2,650.84
| Professional | | $1,023.67 | $1,530.63 | $2,650.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $777.16 / $840.55 / $1,383.40
| Professional | | $777.16 | $840.55 | $1,383.40 |