- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.38 / $985.38 / $1,182.46
| Facility | | $985.38 | $985.38 | $1,182.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $787.48 / $1,051.77 / $1,063.44
| Professional | | $787.48 | $1,051.77 | $1,063.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,220.20 / $1,220.20 / $1,220.20
| Professional | | $1,220.20 | $1,220.20 | $1,220.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,122.47 / $1,122.47 / $1,459.20
| Facility | | $1,122.47 | $1,122.47 | $1,459.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $140.82 / $1,120.48 / $1,156.14
| Professional | | $140.82 | $1,120.48 | $1,156.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $561.58 / $920.35 / $1,629.43
| Professional | | $561.58 | $920.35 | $1,629.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,377.81 / $1,526.58 / $1,942.92
| Professional | | $1,377.81 | $1,526.58 | $1,942.92 |