- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.56 / $1,075.58 / $1,232.30
| Facility | | $970.56 | $1,075.58 | $1,232.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $930.73 / $1,132.20 / $2,051.21
| Professional | | $930.73 | $1,132.20 | $2,051.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.55 / $1,300.55 / $1,300.55
| Facility | | $1,300.55 | $1,300.55 | $1,300.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.40 / $949.40 / $1,300.55
| Professional | | $949.40 | $949.40 | $1,300.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,438.56 / $1,438.56 / $1,438.56
| Facility | | $1,438.56 | $1,438.56 | $1,438.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,252.18 / $1,492.95 / $2,342.54
| Professional | | $1,252.18 | $1,492.95 | $2,342.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $816.58 / $1,256.29 / $1,381.91
| Professional | | $816.58 | $1,256.29 | $1,381.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $915.06 / $1,144.28 / $1,489.67
| Professional | | $915.06 | $1,144.28 | $1,489.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,256.29 / $1,256.29 / $1,256.29
| Professional | | $1,256.29 | $1,256.29 | $1,256.29 |