- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $926.72 / $1,011.51 / $1,399.80
| Facility | | $926.72 | $1,011.51 | $1,399.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $756.74 / $960.89 / $1,244.41
| Professional | | $756.74 | $960.89 | $1,244.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,748.01 / $1,871.21 / $3,496.02
| Facility | | $1,748.01 | $1,871.21 | $3,496.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $941.17 / $968.81 / $1,401.73
| Professional | | $941.17 | $968.81 | $1,401.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,162.20 / $1,162.20 / $1,433.06
| Facility | | $1,162.20 | $1,162.20 | $1,433.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $848.41 / $1,133.66 / $1,433.06
| Professional | | $848.41 | $1,133.66 | $1,433.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.62 / $872.06 / $1,340.94
| Professional | | $660.62 | $872.06 | $1,340.94 |